The positive impact of physical activity on brain performance is not a new concept.

The aphorism ‘I’m going for a walk to clear my head’ has been around for centuries. Ever since the scientific investigation of cognition and exercise began in the 1930s, a growing body of research is showing how being physically active improves a multitude of thinking and memory tasks.

A 2008 article from the journal Nature states “Human and non-human animal studies have shown that aerobic exercise can improve a number of aspects of cognition and performance”.

The same article addresses other effects of physical activity in children. It points out that a growing body of evidence is showing that kids are becoming increasingly sedentary and unfit, making them more likely to develop chronic disease later in life.

This is especially concerning because the article also states “...As a result, recent estimates have indicated that younger generations, for the first time in United States history, might live less healthy lives than their parents.”

Published in the journal Pediatrics, a group of scientists designed a study to establish a direct relationship between physical activity and performance. For the study, “Two hundred twenty-one children (7–9 years) were randomly assigned to a 9-month afterschool PA (physical activity) program or a wait-list control. In addition to changes in fitness (maximal oxygen consumption), electrical activity in the brain (P3-ERP) and behavioral measures (accuracy, reaction time) of executive control were collected by using tasks that modulated attentional inhibition and cognitive flexibility.”

The authors concluded, “The intervention enhanced cognitive performance and brain function during tasks requiring greater executive control. These findings demonstrate a causal effect of a PA program on executive control, and provide support for PA for improving childhood cognition and brain health.”

While further research is being conducted to find the ideal type and duration of exercise, there seems to be enough evidence for most major medical associations to strongly recommend regular physical activity during childhood.

For some local expertise, I spoke to Dr. Carrie Ricci. Dr. Ricci is a pediatrician at Petoskey Child Health Associates in Petoskey.

MYM: How much exercise do you recommend for your patients?

Ricci: “I recommend 60 minutes or more of moderate to vigorous physical activity daily for my patients. The activity should be vigorous at least three days per week. This recommendation can be met either through multiple short periods (at least 10 minutes) throughout the day or a continuous 60-minute period.”

MYM: Is there a specific type of exercise that you suggest to patients and their families?

Ricci: “It is important that the exercise is aerobic. I explain to my patients that this means that their heart should be beating fast, they should be breathing fast and sweating. I do not have a particular exercise or activity that I recommend. I try to brainstorm with the patient and parent(s) to come up with a list of aerobic activities that the child enjoys. My hope is that the patient feels the activities are fun and will stick with them, instead of viewing exercise as a chore.”

The American Academy of Pediatrics has some additional insight regarding exercise for kids.

Who can benefit?

Research has clearly shown that exercise improves cognitive performance in school-age children. The age groups 4-7 and 11-13 showed even more benefit compared to kids in other age ranges. Interestingly, older adults who exercise also showed significantly better performance compared to their sedentary counterparts on psychomotor tasks.

At what age should exercise begin?

As early as possible, it seems. Findings suggest that “... although physical activity might be beneficial at all stages of life, early intervention might be important for the improvement and/or maintenance of cognitive health and function throughout the adult lifespan”.

Jeff Samyn is a Physical Therapist, board certified Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He can be reached via e-mail at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

The second sentence of this column is going to be a disclaimer on the title, because I know it’s going to ruffle some feathers, so here it goes.

When I use the phrase “The Home”, I’m using a specific term that I hear frequently from my patients over the age of 70.

The context is usually along the lines of "I need to improve my balance/mobility/strength so I don’t end up in “The Home.”’

As a physical therapist that has seen patients in many senior “Homes” in the area, I can confidently say that they are not the dreaded, dreary places that many seniors fear when we have these discussions.

I have been in numerous clean facilities with caring staff that provide compassionate care for their patients/residents.

In fact, I have treated patients who transition from barely surviving at (their) home to thriving in (a) home.

Now that we have that out of the way, let’s get to the sentiment behind the statement. What people really fear is losing their independence and their ability to live in the environment of their choosing.

In the past several years, numerous studies have found people with higher muscle strength are less likely to lose their independence than their weaker peers.

An interesting study in the Journals of Gerontology found the stronger an individual’s grip strength, the lower was their overall mortality.

It therefore makes sense if you have a strong desire to maintain your independence as you age, keeping your body strong is one of the most important things to work on. The great news is that regardless of your fitness level, there’s always room for improvement.

I included the graph with this article because I’m a visual learner by nature, and I bet many of you are as well.

I think it nicely shows while losing muscle strength is a normal part of the aging process, people who exercise regularly do a much better job of minimizing that loss.

Your goal should be keeping yourself out of that dreaded disability zone. When our function degrades into that zone, it reflects a loss of independence. (Graph is the maintaining strength as you age one).

For some, that loss may mean relying on a walker or wheelchair to get around. For others it could mean no longer being able to garden or get in and out of a fishing boat. Regardless of your choice in leisure activities, your goal should be to stay out of the disability zone.

If you currently exercise on a regular basis, give yourself a pat on the back.

You’ve already taken the first step. The next step is to try to keep yourself from getting too entrenched in a routine, to the point that your exercise is no longer much of a challenge.

If you don’t currently exercise on a regular basis, perhaps this article has given you some motivation to get started.

After you’ve been cleared to start exercising by your health care provider, a conversation with a physical therapist or athletic trainer is a great way to figure out your current fitness level and find a type of exercise that’s a good fit.

If staying in your own home is important to you, there’s no time like the present to tilt the odds in your favor.

Over the last eight years, that person has been CHS athletics trainer Emily Mahoney, who’s been there to help athletes every step of the way.

CHEBOYGAN — Whenever attending a Cheboygan High School sporting event — whether it’s football, basketball, hockey, soccer, volleyball, you name it — the athletes are the ones people look forward to seeing.

But in order for those athletes to be in the best condition — especially health-wise — there always has to be someone there to look over them and make sure they’re safe.

Over the last eight years, that person has been CHS athletics trainer Emily Mahoney, who’s been there to help athletes every step of the way.

Since she started back in 2012, it’s been quite the journey for Mahoney, an employee at Northern Michigan Sports Medicine Center (NMSMC).

Whether it’s the mornings where she works at NMSMC-Cheboygan with seven to eight patients per day, or the afternoons and evenings where she treats athletes at the high school, it’s usually busy for Mahoney.

In her case, she wouldn’t rather have it any other way.

“I like having a wide variety of clients and students in varied work settings each day,” said Mahoney, who graduated from Central Michigan University with a Bachelor’s Degree in Sports Medicine and Athletic Training. “I enjoy the challenge of the unknown, I suppose. It’s very rewarding working with the student-athletes, and I’m happy to be able to have a positive influence on them. Cheboygan is a great place to live. I like the small-town feel, I like that I’m respected amidst most of the community.”

For Mahoney, there’s an abundance of tasks — taping athletes, evaluations, checking on prior injuries, meeting with coaches, calling parents and doctors, watching practices, making sure everybody’s feeling well — to deal with every single day.

During football season, days — and nights, in particular — feel a bit longer for Mahoney, who travels with the Cheboygan varsity team to away games.

Things can get a little stressful — and hectic, at times — for Mahoney, but at the end of the day there’s those two people there to help her unwind at home after each day.

Those would be her husband, Joe, who works as a physical education teacher at Inland Lakes, as well as her four-year-old daughter Harper.

“Every day in this profession is not easy. In some cases, I will have to treat several injuries and assess playing status at a moment’s notice,” Mahoney said. “I must admit that even my adrenaline is ramped up during athletic events. At the end of the day, it’s my job to ensure each athlete’s safety and health and communicate that with parents, coaches and physicians. There’s a high burnout rate in many health professions, athletic trainers especially. My husband has taught me to leave my work at the door and thoroughly appreciate the time I have with family and loved ones.”

When it comes to working with athletes, Mahoney is exceptional at what she does.

What exactly is the secret to having a good working relationship with the kids?

Well, having an easy-going personality definitely helps.

“I think I’m pretty laid back,” Mahoney said. “I try to develop a good rapport with the students so that I am more approachable when injuries occur. The first time they meet me they’re a little nervous, but as they get to know me through conversations at practices and competitions, they become more comfortable with me, and I’m pretty fun.”

When it comes to coaches who work with Mahoney, they know she’s the right person to go to.

And they have a huge appreciation for her.

“Emily does a great job of making sure the kids are kept safe on the field in football, first of all, making sure the kids are taken care of,” said Cheboygan junior varsity football coach Scott Kelley. “She’s also very good at determining when they’re able to go and if they’re able to go, which is a very difficult thing sometimes. She has rapport with the kids, also. The kids have a lot of respect for her, and she has a lot of respect for the kids and for their desire to play the game, and she has a great desire to get them back on the floor, on the field or wherever after they’ve been injured or after they’ve had some kind of situation.

“The kids have a great respect for her. As far as coaches go, I have a great respect for her. I talk to her daily about, ‘Is this kid ready to go, is this kid not ready to go?’ and she’s really honest about it. She’s really upfront about what’s going on with those kids. She also is a great person to communicate with the parents, and she’s a very easy person to go to to ask advice. Great rapport with the kids, also a great rapport with the coaches.”

The honesty shown by Mahoney has been appreciated by several other coaches, especially Cheboygan hockey coach Craig Coxe, who’s worked with her for eight seasons now.

“I think Emily’s awesome, I think she does a great job,” said Coxe. “She’s been around sports for a long time. She knows if a player is not really hurt or not. In all sports, some players will try to milk it a little bit, but one of the things I respect the most about Emily is whatever question I ask her, she’s going to shoot me straight, and I really, really enjoy that about her.”

For Mahoney, it’s never been about her. It’s always been about the athletes she helps out.

“I think the most rewarding part of my job would be seeing a student-athlete through the entire process of being injured to getting back to the game they love ,” Mahoney said. “I enjoy seeing them progress through physical therapy with me at 7 a.m. and in the afternoon at the school, and realizing they are accomplishing the goals they made to get them stronger and ready to play.”

In the end, Mahoney loves her job as much as when she started over 10 years ago.

But what she cherishes most is the positive feedback from the Cheboygan athletic community.

“It’s really gratifying for any parent, coach, or patient to come up to me after the fact and say, ‘Hey, I appreciate what you did for my kid or what you did for myself,‘” Mahoney said. “It’s good to see that, it’s good to have kids come back from college and just say ‘hi’ to me, so I know that I made some type of impact on them. Cheboygan is a great community and I’m happy to be part of the athletics family.”

A few of my favorites are the Holiday Open House, family get-togethers and not having to cut my grass.

Unfortunately, the season also brings a subset of injuries I especially hate to see — those which stem from falling at home or outside.

The risk of falling is elevated this time of year because of the presence of ice, the need to walk on uneven snow and the fact that people are generally less active, leading to reductions in strength and flexibility.

To learn more about the risks associated with falling beyond fractures, bumps, and bruises, I spoke to Dr. Wendy Walker. Dr. Walker is board certified in family medicine and is an MDVIP affiliate physician at Little Traverse Primary Care in Harbor Springs.

MYM: Other than the obvious bumps and bruises, what types of injuries usually result from falling?

Walker: “We typically see fractured ribs, hip fractures, and spinal compression fractures from falls. We also can see severe skin tears and lacerations in the elderly in particular. Large hematomas of the limbs are common in people who fall and are on blood thinners.”

MYM: Which patient populations are most vulnerable to falling?

Walker: “Patients 65 and older, patients with cognitive decline or lack of insight or awareness of their surroundings, those who use a brace or cane or walker or who have an artificial limb, those who use oxygen (they trip on the cord) and those with balance problems such as Parkinson’s or Peripheral Neuropathy are most likely to fall.”

MYM: Other than the actual injury, what are somesecondary health problems associated with falling?

Walker: “In the elderly, a high percentage of people who sustain a hip fracture either die or go to a nursing home. Pneumonia is a common complication of rib fractures. Blood clots can occur in the legs or lungs post orthopedic injuries that require immobilization. A head injury can lead to post-concussion syndrome which effects sleep and concentration, and can cause headaches and other symptoms.”

MYM: What advice do you give your patients who are especially afraid of falling in the winter?

Walker: “I recommend that people who use canes to put a cane spike on the end of the cane in the winter. They should wear good boots with tracks or add “Yak Tracks” or other similar device to their boots. They should avoid ice and if they are at high risk they should park close to their destination and walk with someone who can assist them. If they are afraid of walking in the snow to exercise, I recommend considering snow shoes. There are many Northern Michigan trails.”

Here are a few more steps you can take to reduce your risk of falling:

Shorten your stride

While we normally encourage nice long steps when walking, your stride should be shorter when walking on slippery or uneven ground. This results in your center of gravity staying over your base of support, reducing the chance of slipping or tipping.

Gear-up

Stores in the area carry several items you can use to reduce your fall risk. External traction devices can be great for snow and ice-covered ground, but be careful wearing them on bare cement. A quick internet search for “ice and snow traction cleats” will provide several possibilities. Another great idea is to bring a ski or hiking pole with you to give you another point of contact with the ground, increasing your stability.

Get some PT

All the equipment in the world won’t help if your reaction time, flexibility, and strength are not sufficient to keep you upright if you slip. Spending 2-3 days per week working on keeping yourself strong and flexible will go a long way towards reducing your fall risk.

Jeff Samyn is a Physical Therapist, board certified Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He can be reached via e-mail at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

This is a question that I am asked by my patients at least once a week, especially during the winter months.

Stiffness is experienced by nearly all ages and across a wide range of activity levels. I actually remember the exact day I first experienced unexpected stiffness that made me realize my body wasn’t as pliable as it once had been.

I was living in the dorms at Central Michigan University in 2001. The first big snow fall came right around this time of year, just before finals week.

My roommates and I organized a dorm-wide snowball fight by calling every room and telling them to meet in the quad at 7 p.m. to throw down. We had an epic battle with hundreds of people participating, and while a winner was never declared, I feel that our side won the day.

The next day, however, we did not feel like the victors.

Good heavens, the soreness.

In high school I expected that type of soreness after football practice, but not a snowball fight. Our 20-year-old bodies were so stiff the next day that none of us went to our early morning classes. I remember thinking my body wasn’t supposed to feel old until I actually was old.

You know, like over 30.

The specific type of stiffness I experienced for the first time all those years ago was delayed onset muscle soreness (DOMS). This is characterized by pain and stiffness throughout the body that occurs about 12-48 hours after an intense or novel activity.

Even though I was a regular in the weight room at CMU, my body wasn’t used to the speed at which I was hurling the snow, which is why I got sore even though I wasn’t “weak.”

You may have experienced DOMS after doing some work around the house.

Did you spend two hours cleaning out your car and have trouble standing up the next morning? That was likely DOMS of the low back extensor muscle group. Did you scrub every window in your home and have trouble raising your arm the next day? DOMS of the shoulder elevators was likely the culprit.

The other common type of stiffness that people complain about is that which occurs first thing in the morning. I typically hear something like “my knees and back are just so stiff when I get up. They get better after I shower and move around for an hour or so, but boy does it slow me down.”

The most effective way I’ve found to address this type of stiffness is to deploy my favorite saying: motion is lotion. Gentle, pain-free movement performed before getting out of bed or immediately after doing so is the best way to fight off morning rigidity. As you move, blood and other joint fluids starts pumping through your body at a higher rate than when you were asleep, leading to improved motion and less muscle pain.

It can be amazing what just two minutes of pain-free movement can do to improve your early morning mobility. Give this a try and see if your back isn’t a little more limber during the first hour of your day:

— As soon as you wake, bend your knees up to about 90 degrees, keeping your feel flat on the mattress.

— Keeping your feet and knees together, rotate them gently from side to side for about 30 seconds at a steady rate.

— Then try grabbing one knee at a time and slowly pull it towards your chest. Hold this for about 30 seconds then repeat on the other side.

— Now get up and get on with your day.

Jeff Samyn is a Physical Therapist, board certified Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He can be reached via e-mail at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

Back pain during pregnancy is no laughing matter, as any mom-to-be with back pain can attest.

Many pregnant women are told not to worry and that the pain will eventually pass, which it sometimes does without intervention. However, while it may be common to have low back pain during pregnancy, it doesn’t mean it should be accepted when there are ways to manage or improve the pain.

Some sobering statistics:

— 49-76 percent of women will experience low back pain during pregnancy

— There is strong evidence that a woman is at a higher risk of having low back pain during pregnancy if she has a prior history of low back pain or prior trauma to the pelvis

— Women with low back pain during pregnancy have greater risk for low back pain postpartum with 37 percent reporting pain at 18 months postpartum

For the sake of simplicity, “low back pain” will refer to pain in the lumbar spine, sacroiliac joints and/or buttocks (in physical therapy we often make a distinction between low back pain and pelvic girdle pain).

Risk factors for developing back pain during pregnancy according to the journal Spine include:

— history of previous low back pain

— previous trauma to the pelvis

— high work load

— having given birth 2 or more times

— higher body mass index

— history of hypermobility (increased range of motion of joints; joint laxity)

— amenorrhea (history of absence of menstrual periods)

There are many ways to treat low back pain in pregnancy.

One approach is to tough it out and hope that the pain will disappear after delivering the baby. I know few professionals or pregnant women who are comfortable with that approach. Most professionals would recommend determining the cause(s) of the pain and developing a custom-made intervention plan to address each woman’s specific issues. There are many different potential treatments for low back pain, including:

— over the counter analgesics (consult with your OB/physician)

— use of heat or ice to the painful area for 10-15 minutes

— exercise (prenatal exercise classes, water exercise, prenatal yoga with specially trained instructors. If pain persists, physical therapy will customize the exercise program based on the individual)

In the years that I have worked with pregnant women in physical therapy or in my prenatal exercise class, I see a common theme – women don’t want to do anything “wrong” that could potentially compromise the health of their child. This is why it’s very important to treat every pregnant woman with back pain individually vs. having them guess on their own ways to decrease their pain.

When a referral is made to a physical therapist, the woman sits down with a therapist and discusses her history and concerns and then receives a comprehensive evaluation and treatment plan. The physical therapist will then provide her with direction in how to manage her back pain.

It may take just a few visits for a woman who is experiencing back pain for the first time. For those pregnant women who have had back pain prior to pregnancy, they may need more visits and intervention to get to the point that they feel they can manage their pain if it is still present.

Another fact that can’t be ignored is the 37 percent or more that still have back pain postpartum. Managing or eliminating back pain during pregnancy should have an effect on reducing postpartum pain. Yet some women will need to return to PT to work on this in the postpartum period (in addition to the abdominals and pelvic floor muscles).

In conclusion, while low back pain can be common during pregnancy, there is often a way to manage or resolve the source of the problem. Consultation with a physical therapist can go a long way towards minimizing your back pain and maximizing your mobility.

Taking control of the pain will hopefully allow you to focus on what you should be doing — enjoying your pregnancy.

Sandy Sparrow is a physical therapist, certified strength and conditioning specialist and is certified in pregnancy and postpartum physical therapy. Sparrow is the leader of Northern Michigan Sports Medicine Center’s Women Health program. She may be reached for questions at ssparrow@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

Americans will spend 19 billion hours traveling to see family and friends this year, logging more than 1.1 trillion miles in the sky, on the road and on the rails.

While I may have made those numbers up, the point is many of us will be spending hours on-end over the next six weeks sitting and moving in ways which we are not accustomed to.

Whether it will be spending four hours in the car to catch a plane out of Detroit or loading suitcases and bags into overhead bins, holiday travel imposes different types of strain than we experience other times throughout the year.

We twist awkwardly to get out of ever-shrinking plane seats, pack more weight into our carry-ons to prevent our bags going over the weight limit and sometimes have to sprint through terminals to make up time from delayed flights.

If you’re a regular reader of this column, you know an ounce of prevention is worth a pound of cure.

Keeping your body strong and flexible goes a long way toward reducing the chance of injuring yourself both around the house and while traveling.

That being said, even fit and flexible folks sometimes develop sprains and strains when they are rushing through airports and hurrying to unpack to see their family.

Here are a few tips to make your journey over the river and through the woods more comfortable:

Freely move about the cabin

Regardless of your mode of transportation, it is best to change position every 1-2 hours, or even more often if possible.

Getting up to walk the aisles on planes and trains whenever you’re able can prevent your back and neck from getting stiff.

When driving, it is very helpfully to stop, get out, and walk around for 2-5 minutes every 1 1/2-2 hours. Doing so keeps your muscles, ligaments and tendons warm and pliable.

Take turns when driving

If you are normally the driver on trips longer than 3-4 hours and have a willing and able passenger, take turns knocking off a couple hours each.

Being in the passenger seat and having the ability to recline for 15-20 minutes can unload the structures of your spine that tend to get stiff after hours of upright sitting.

Move boxes and luggage like a T-Rex

Pretending you have short little arms is actually a great way to reduce the likelihood of injuries to your spine and arms.

Objects positioned further from your torso require more strength to lift, and higher muscle forces produce more stress on the spine and joints.

To offset the strain, keep suitcases, boxes, and bags as close to your body as possible, whether you’re lifting them out of a trunk or placing them into an overhead bin.

Finally, if you have an existing injury or perhaps have had surgery recently, get some help. Airports have carts and personnel available to help get people and their belongings from point A to point B.

While it may cost a few dollars for that convenience, it will likely be cheaper than a trip to an urgent care center in your destination city.

Jeff Samyn is a physical therapist, board-certified orthopedic clinical specialist and certified strength and conditioning specialist at Northern Michigan Sports Medicine Center in Petoskey. He may be reached via email at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

Back pain is among the most common reasons for patients to seek medical care, with some estimates that as many as 80 percent of the population will experience lumbar pain at some point in their life.

Fortunately, most episodes of pain are self-limiting and resolve within 2-4 weeks.

Surgery is always the last resort when it comes to addressing low back pain, and depending on the anatomic issue being addressed, recovery times can vary widely.

Surgical outcomes can be drastically different depending on the condition of the patient before they undergo surgery.

Things like decreased muscle mass, obesity, having a sedentary lifestyle, smoking status and the presence of diabetes can all reduce the chances of a good surgical outcome to varying degrees.

To learn more about back surgery and recovery, I spoke with Dr. Tony Bozzio from Bay Street Orthopedics. Bozzio sees patients in Petoskey, Charlevoix, Rogers City and Gaylord.

MYM: How does a patient know when it is time to consult a surgeon about their back pain?

Bozzio: “In terms of back pain alone, there are several types and treatment can differ based on age. Any of the following should be evaluated sooner rather than later:

— Back pain which begins after injury, such as a severe fall or car accident

— Persistent pain in younger patients longer than a month or two in duration

— Pain which develops in elderly patients with osteoporosis due to the risk of compression fracture.

I try to see these patients within a few days to expedite their care and limit time in wheelchairs or being bed bound.

For the more generalized lower back pain that I think you are referring to, I think its time to see a surgeon when quality of life is an issue. If someone is unable to cope with lower back pain, they should see a spine surgeon for an opinion. A detailed history, exam, specialized x-rays, and MRI can give valuable information and help guide treatment.”

MYM: Are there any interventions that are considered before surgery is decided upon as the best option for relief?

Bozzio: “I tend to be very conservative for low back pain and use physical therapy extensively with good results. With certain types of back pain, injections can sometimes be helpful.”

MYM: What are some of the considerations that a surgeon reviews with the patient when deciding whether to proceed with surgery?

Bozzio: “There are two main considerations. The first is deciding if a surgery will solve the problem. The second is evaluating if symptoms are severe enough that quality of life is being impacted or if someone is unable to do the things they want to do or need to do. Then the risks of surgery have to be weighed against the benefits.”

MYM: What is the typical recovery time after surgery, and when can people get back to activities like skiing or cycling?

Bozzio: “Recovery all depends on the type of surgery and everyone is different. For smaller lumbar spine surgeries, the recovery can be weeks. For larger surgeries it can really take up to three to six months before people are back skiing and biking.”

Jeff Samyn is a Physical Therapist, board certified Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He can be reached via e-mail at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

With the leaves quickly falling from the trees and the upcoming storms of October and November on their way, anticipation of the upcoming ski season grows by the day.

Soon the snow-makers at our local ski resorts will be creating a winter wonderland for skiers and snowboarders to enjoy.

While we are looking forward to a full season of carving turns, nothing brings this enjoyment to a halt faster than an unexpected injury.

Among downhill skiers, knee injuries are the most common type of injury sustained from a fall. In fact, they occur three times more frequently than any other type of injury. The most commonly injured knee structure is the medial collateral ligament (MCL), followed closely by the anterior cruciate ligament (ACL).

Injury to these ligaments from a fall while skiing is most commonly caused by the shin twisting outwards relative to the thigh, resulting in an incredible amount of stress being put on the MCL and ACL.

These ligaments’ primary role is to resist this type of stress to the knee. The MCL, fortunately, has a very good potential to heal and recover with conservative care.

Injury to the ACL on the other hand is more serious and often requires surgery to repair/reconstruct. Surgery is almost always followed by a lengthy rehabilitation period. Prevention of either of these injuries is crucial if you want to make it through the ski season.

The following are top 3 ways to protect your ACL while skiing this winter:

Equipment

Avoiding a fall is key to eliminating knee injuries while skiing.

Downhill skis, by design, create a longer lever arm which creates torque at the knee joint. Longer, more traditional skis create even more of a lever arm.

Conversely, shorter, shaped skis with shorter tails make turning easier and reduce the strain at the knee joint.

This is a good time of year to re-evaluate your skis and consider up-grading to shorter, easier carving skis. In addition to your skis, the binding settings can play a huge role in reducing your risk of an ACL injury.

Bindings are intended to keep your boots attached to the skis. When you fall, if the bindings release, it allows your ski to come off, reducing the torqueing of the ski on your knee.

The higher the setting, the less likely the ski is to release. Properly set bindings are a function of your height, weight, skiing ability, and the skiing conditions. This is best assessed by a ski tuning professional at one of our local ski shops or ski resorts.

Fitness

Suffice it to say, your body is the most important piece of equipment you have.

The more conditioned and the stronger it is, the more ability you have to prevent injury. During this time we are waiting for snow, get started on a strength and conditioning program that targets your quadriceps, hamstrings, gluteals and abdominal muscles.

The key is to have a conversation with a fitness professional to see what you need to focus on.

Skiing ability

The adage of skiing within your ability continues to hold true. Sticking with ski runs and speeds that are within your ability allows you to stay in control and minimize your risk of falling, reducing the potential for a season ending ACL injury.

Following friends into uncharted terrain that is beyond your own ability can push you beyond your ability to stay in control of your skis. This is often a recipe for disaster.

Hopefully, the snow will be flying soon, so there is no time like the present to get your equipment in good working order. Have fun and have a safe ski season!

Opening day for rifle season 2018 is about 6 weeks away, and that means many across Northern Michigan are starting to air out their thermal gear and sight in their rifles.

Responsible hunters generally do a great job preparing for the big day by making sure their equipment is in good working order.

Unfortunately, there is one key piece of equipment that is often ignored: their body.

From falls while walking in the woods to back injuries from dragging trophies back to camp, physical therapists tend to see an uptick in hunting-related injuries the week or two after the season opens. Fortunately, an ounce of pre-season prevention can help ensure part of the season isn’t missed because of injury.

Here are a few areas to think about while there is still time to make some improvements.

Heart and lungs

For many hunters, walking through the woods and (if they’re lucky) dragging out a deer will be the most intense exercise they will get all year.

A casual springtime morel hunt in the forest is one thing, walking through the woods in full hunting gear while carrying 20-25 pounds of gear is another. Imagine carrying three gallons of milk on your back during your trek to the blind.

This will get your heart rate up and likely get you breathing heavily by the time you arrive. Every year, we hear about a few hunters that have heart attacks on opening morning, and the increased cardiac demand is often a contributor.

Muscles and joints

Depending on how Mother Nature treats us this fall, you may be wearing several layers in the woods this winter. Warmth is good, but for every added layer, you lose a little flexibility and mobility.

If your body is already tight and stiff to begin with, climbing up into that tree-stand may become more difficult and dangerous than if you had your street clothes on.

The best way to compensate for the extra layers is to work on improving your flexibility before you head into the woods. Hunters tend to be tight in their upper back, chest (pecs), and shoulders, so those are a few great places to start. It is worth noting, however, that each stretch isn’t necessarily needed by everyone, so it’s best to see a physical therapist or athletic trainer for specific recommendations.

Balance

Stepping over fallen branches and trees in dry weather is difficult enough; doing so in the snow can be significantly more challenging.

Our balance system requires the cooperation of our vision, inner ear, and proprioception. If any of those 3 systems are compromised, the risk of a fall increases unless the others are able to compensate. Many falls occur on the way into or out of the woods at dusk and dawn.

Because these usually happen in the dark, it is important that the other two balance systems are ready and able to stabilize the body.

To ensure you have a long and safe hunting season:

Get your yearly physical

Some avid hunters schedule their physicals in September or October so they know they’re good to go before opening day. If you’re over 50 and haven’t had a physical in a while, call your doctor to set one up.

Get your heart rate up

If you’re not used to getting much cardio exercise, now is the time to start.

And no, unfortunately, walking around at work or around the house all day does not count, at least as far as your heart and lungs are concerned. There are lots of other ways to improve your cardio function, including biking, using a treadmill, and interval strength training. Pick one that fits into your lifestyle and get started at least 6 weeks before the big day.

Get flexible

It may surprise you to learn that you can actually improve your flexibility in just a week or two. Since not everyone is tight in the same areas, stick to general mobility exercises or see your physical therapist for a custom program.

Check your balance

This is crucial for hunters over 55. If you can’t stand on one foot for at least 30 seconds, your risk of falling is increased. A great drill to improve balance is to just work on standing on one foot for about 30-45 seconds a few times/day.

If you do end up tripping or slipping on logs or under brush, your ability to prevent a fall will be better.

Jeff Samyn, PT, OCS, CSCS is a Physical Therapist, Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He can be reached via e-mail at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

It probably isn’t news to anyone we’re in the midst of an opioid crisis at the national, state and local level.

According to the Centers for Disease Control and Prevention (CDC), in 2016 more than 42,000 people in the United States died from an opioid overdose, including more than 17,000 whose deaths were attributed to prescription opioid overdoses.

That’s almost 50 lives lost every day. Deaths caused by overdose of prescription opioids have quadrupled over the past 15 years.

While the mechanisms behind this increase in opioid related deaths are multifactorial, there is a concerted and growing effort being made to reduce the amount of opioids consumed by people in pain.

Opioids remain an effective tool for addressing certain types of pain when prescribed and taken correctly. That being said, in the past few months, our physical therapy practice has been affected by efforts aimed at reducing opioid use.

More than ever, physical therapists are serving as educators and coaches

I have worked with many patients between the ages of 25—85 over the past 12 months who are working with their healthcare provider to reduce the amount of opioid medications they are taking.

One of the possible effects of prolonged use of these medications is called opioid-induced hyperalgesia. This means that some patients who are given opioid medications actually become more sensitive to pain.

Some even start to experience pain with activities that never caused it before. According to the Journal of Neuroscience, this phenomenon has been observed in animal models after just a single large dose of opioids.

As the dose of opioids is reduced, patients are often unsure what types of pain they should work through and which types they should avoid. Physical therapists who have had comprehensive training in pain education and management help guide patients through this process.

We’re seeing patients earlier in the injury/recovery process

According the American Physical Therapy Association’s white paper on pain management: “The treatment of pain, particularly chronic pain, often requires an integrated, multidisciplinary approach due to the many variables that may contribute to a patient’s perception of pain and response to treatment.”

Given the subjective nature of pain, it is among the most complex problems for a healthcare provider to address. Contributing factors to how one person handles pain compared to another include stress levels, work and relationship satisfaction, fitness level, diet, and past experience with pain, to name a few.

All of these must be taken into consideration when a treatment plan for pain is formulated.

The combination of increased awareness of opioid-related issues and changes to prescribing laws has moved physical therapy up the list of suggested treatment options for pain of all types and moved opioids down the list.

As a result, we are seeing patients for the first time a few days or weeks after the start of their pain, as opposed to months later.

In summary, as physical therapists, our role is to be educators and coaches. We reinforce pain education concepts that are introduced by the patient’s physician, troubleshoot barriers to improvement that pop-up at home or at work, reduce the fear associated with injury, and teach patients how to move safely as they heal.

Though we are in the early phases of addressing this epidemic, the medical community is figuring out safer and more effective ways to help patients in pain.

Jeff Samyn is a Physical Therapist, board certified Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He can be reached via e-mail at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

We’ve been searching for the proverbial fountain of youth for centuries, and while modern medicine has extended our life expectancy a great deal, it has not always added quality to our later decades.

Time for some definitions. While lifespan refers to the total number of trips around the sun, healthspan refers to the quality of life during those years.

According to the World Health Organization the average life expectancy is 79 years. They put the average healthspan, however, at 63 years old. To put it another way, the average person spends at least 20 percent of their life in poor health.

If you have at least a few friends or loved ones over 70, chances are that you’ve begun to notice a widening gap between those who are still out skiing every other day and those who need a few tries to stand from a chair.

In my physical therapy practice, I start to notice a change in my more sedentary clients around their mid-60s which accelerates into the 70s and 80s.

Getting down to brass-tacks, the human body was made to move. I like to borrow a phrase from Sir Isaac Newton when he described his first law of motion: “Every object persists in its state of rest or uniform motion…unless it is compelled to change that state by forces impressed upon it.”

In other words, if you don’t stay active, you’re going to find it increasingly difficult to do the things you like to do.

In your 20s-30s, this may mean no longer being able to participate in pick-up basketball or soccer. In your 40s-50s, you may have a hard time keeping up with your teenagers in their sport of choice.

Starting around your 50s and extending into your 80s-90s, you will likely find normal everyday activities are getting difficult. This may range from stiffness in your back for the first hour after waking to needing to give up golf because you just seem to keep getting injured.

Despite the wide range in activity and life stages outlined above, increasing or maintaining an active lifestyle is the common denominator that will improve your ability regardless of your age or level of intensity.

If you’re motivated to get on track or keep yourself moving, I’d encourage you to schedule an annual check-up with your physical therapist. We meet regularly with clients who have diverse needs.

Some may need help starting a daily walking program while others may be looking to improve their performance. Our job is to meet you where you’re at, work with you to outline a plan that fits your life, and help keep you accountable year to year.

Many people wait until Jan. 1 to start making changes that will improve their health.

How great would it be to give yourself a few month’s head-start this year?

Jeff Samyn is a Physical Therapist, board certified Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He can be reached via e-mail at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

Although it will (hopefully) be several months before the snow and ice start flying, September is a great month to start thinking about lowering your fall risk.

The good news is that it only takes 1-2 months to significantly improve your strength, flexibility, and balance, all of which work with other body systems to keep you steady.

Research has shown time and again that improvement in these areas has a significant impact on reducing the likelihood that an individual will fall.

When we address balance problems in physical therapy, we start by assessing our patient’s fall risk. There are several standardized tests that can be used for risk stratification and to set baselines.

A quick test that can be performed easily at home is to stand on 1 foot with your eyes open and hands on your hips. Make sure not to hook the lifted leg on the standing leg. If you’re unable to hold this for 10-15 seconds, you may be at an elevated risk of falling.

To learn more about falls and fall prevention from a physician’s perspective, I spoke to Dr. Maureen Doull.

In your practice, at what age do you start to notice an increase in reported falls from your patients?

Doull: "Fall are very common in my practice and the incidence increases with age. Between 30-40 percent of people over 65 fall each year, and 50 percent of people over 80 fall each year. About 5-10 percent of falls result in a major injury such as fracture, head trauma, or major laceration. Unfortunately, most minor falls are never reported to physicians or other family members."

Generally speaking, what are a few common contributing factors to falling?

What are some things you recommend to your patients who have had a fall that resulted in an office visit?

Doull: "To determine the best intervention, we start by assessing their physical strength and balance with a few tests such as gait speed, raising from a chair (no hands allowed), or a timed up and go test. We encourage exercise or refer to physical therapy for strength and balance training.

"The provider will review the patient’s blood pressures and stop or discourage psychotropic drugs and encourage good nutrition. Depending on the circumstances, we may consider a home safety evaluation with recommendations such as grab bars, stair railings, non-slip rugs and bath mats, improved lighting, etc."

If a person hasn't fallen and wants to keep it that way, what can they can do to reduce their risk?

Doull: "Studies show benefit from group or home based exercise programs focused on muscle strengthening and balance, at least 3 hours/week. Exercise alone can decrease the rate of falls by 21 percent. It is important to avoid psychotropic drugs and remove home hazards. There is some evidence that Vitamin D-3 supplementation is beneficial if the patient is at risk for Vitamin D deficiency or has muscle weakness or balance problems."

Jeff Samyn is a Physical Therapist, board certified Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He can be reached via e-mail at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

It probably isn’t news to anyone we’re in the midst of an opioid crisis at the national, state and local level.

According to the Centers for Disease Control and Prevention (CDC), in 2016 more than 42,000 people in the United States died from an opioid overdose, including more than 17,000 whose deaths were attributed to prescription opioid overdoses.

That’s almost 50 lives lost every day. Deaths caused by overdose of prescription opioids have quadrupled over the past 15 years.

While the mechanisms behind this increase in opioid related deaths are multifactorial, there is a concerted and growing effort being made to reduce the amount of opioids consumed by people in pain.

Opioids remain an effective tool for addressing certain types of pain when prescribed and taken correctly. That being said, in the past few months, our physical therapy practice has been affected by efforts aimed at reducing opioid use.

More than ever, physical therapists are serving as educators and coaches

I have worked with many patients between the ages of 25—85 over the past 12 months who are working with their healthcare provider to reduce the amount of opioid medications they are taking.

One of the possible effects of prolonged use of these medications is called opioid-induced hyperalgesia. This means that some patients who are given opioid medications actually become more sensitive to pain.

Some even start to experience pain with activities that never caused it before. According to the Journal of Neuroscience, this phenomenon has been observed in animal models after just a single large dose of opioids.

As the dose of opioids is reduced, patients are often unsure what types of pain they should work through and which types they should avoid. Physical therapists who have had comprehensive training in pain education and management help guide patients through this process.

We’re seeing patients earlier in the injury/recovery process

According the American Physical Therapy Association’s white paper on pain management: “The treatment of pain, particularly chronic pain, often requires an integrated, multidisciplinary approach due to the many variables that may contribute to a patient’s perception of pain and response to treatment.”

Given the subjective nature of pain, it is among the most complex problems for a healthcare provider to address. Contributing factors to how one person handles pain compared to another include stress levels, work and relationship satisfaction, fitness level, diet, and past experience with pain, to name a few.

All of these must be taken into consideration when a treatment plan for pain is formulated.

The combination of increased awareness of opioid-related issues and changes to prescribing laws has moved physical therapy up the list of suggested treatment options for pain of all types and moved opioids down the list.

As a result, we are seeing patients for the first time a few days or weeks after the start of their pain, as opposed to months later.

In summary, as physical therapists, our role is to be educators and coaches. We reinforce pain education concepts that are introduced by the patient’s physician, troubleshoot barriers to improvement that pop-up at home or at work, reduce the fear associated with injury, and teach patients how to move safely as they heal.

Though we are in the early phases of addressing this epidemic, the medical community is figuring out safer and more effective ways to help patients in pain.

Jeff Samyn is a Physical Therapist, board certified Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He can be reached via e-mail at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

The 2018 football season is fast approaching and that means concussions are once again a hot topic on sports pages across the country. Unfortunately, concussion risk comes with the territory any time a sport involves contact between participants.

However, concussions are not just sustained by those engaged in tackling sports.

To understand the identification and prevention of concussions among athletes, I spoke with Dr. Todd Sheperd of Bayside Family and Sports Medicine in Petoskey and Lindsey Griffes, Athletic Trainer at Northern Michigan Sports Medicine Center who covers Petoskey High School athletics.

Both sports medicine professionals are frequently on the sidelines of high school football, hockey and basketball games throughout Northern Michigan during the school year.

Which sports or activities tend to have a higher frequency of concussions?

Dr. Todd Sheperd (TS): “Collision sports have the highest risk of concussion injuries. These sports include primarily football and hockey, both of which have rules that allow players to intentionally collide with the opponent. Even though non-contact sports (like soccer and basketball) have rules restricting intentional collisions, concussions still happen when players collide with each other or the ground.”

Are all concussions the same?

TS: “No, not all concussions are the same. Some have rapid recovery on the sideline and have very few lingering effects, while others can have symptoms which last for weeks or months and can interfere with both school and sports participation and performance.”

How do you recognize a concussion on the field?

Lindsey Griffes (LG): “The most obvious sign is observing an athlete take a hit to the head. Physical signs of a concussion may include the athlete appearing dazed or confused, mood or behavior changes that are out of character for the athlete, or tripping/stumbling. Cognitive signs including impaired response time to questions about time of day or the date, slowed or abnormal speech patterns, or not being able to recall events right before the injury are also indicators.”

What symptoms might a person with a concussion report?

LG: “Headache, dizziness, fatigue, sensitivity to light and sounds, vision problems, finding it difficult to focus or concentrate, feeling “in a fog” or “not right”, or general confusion.”

What kind of sideline testing do you perform to determine the severity of the concussion?

LG: “The tests which determine the severity of injury varies with each athlete. Generally we start by assessing the signs and symptoms mentioned above. I then assess cranial nerve function, as there are 12 cranial nerves which emerge from the brain and brainstem, all of which can be tested quickly on the sideline. If the athlete fails any portions of my assessment they are immediately removed from play and coaches and parents are informed during the game or practice. They may be referred to their health care provider for further evaluation and management.”

“If an athlete passes all of the cognitive tests and are symptom free, I will then perform a functional sideline test, the purpose of which is the engage the athlete in physical activity to see if any signs or symptoms manifest. Activities may include: running, sprinting, jumping, push-ups, or any other physical activity that gets the athlete moving without being placed back into the game or practice.”

What are the short and long term effects of a concussion?

TS: “Short term effects include pain, changes in neurologic function (confusion, poor balance, lightheadedness etc.) as well as behavioral changes (mood, decreased concentration, irritability and poor sleep). Long term effects are more difficult to determine. Data suggests repetitive injuries to the brain can be associated with permanent impairment in memory (dementia), behavior (depression and other mood disorders) and movement disorders (sometimes similar to Parkinson’s disease).”

“There are multiple researchers currently investigating the long-term side effects related to concussion and other types of brain injuries (such as combat related injuries). One condition in particular has gained significant exposure in the press: Chronic Traumatic Encephalopathy (CTE). This condition appears to be related to repetitive head injuries and may develop symptoms involving behavioral changes as well as loss of memory and movement changes.”

“CTE was the subject of a recent major motion picture, and several former NFL players have had concerns regarding the development of this condition (although CTE is only clinically diagnosed after autopsy). There are many unknowns regarding how concussions may lead to CTE. Questions about factors such as genetic background, severity and number of head injuries as well as other risks including prior history of behavioral problems (depression, substance use) still need to be answered to allow sports medicine providers counsel their patients about the potential long term risks of repetitive head injuries.”

What can coaches, players, and parents due to prevent concussions?

TS: “The most consistent way to prevent concussions is to reduce the number of collisions and the energy involved in the impact. Despite the claims of many equipment manufacturers, adding additional layers of armor makes no significant change in the rates of concussions. Enforcing rules and changing player behavior, however, does reduce the risk of concussion in sports. For example, illegal checking in hockey and spearing in football often lead to concussions.”

LG: “The most effective action that can be taken is to follow and enforce the rules of the sport that are meant to ensure safe practices and games. These include avoiding hits to the head in football (targeting) and removing the athlete from play if headwear comes off or is not fitting properly.”

Jeff Samyn is a Physical Therapist, board certified Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He can be reached via e-mail at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

Which type of hip replacement is right?

Hip pain which is caused by arthritis is one of the most common diagnoses treated by physical therapists.

In most cases, treatment results in significant reductions in pain and disability, leading to improved participation in leisure activities like gardening, golf and tennis.

In very advanced cases of arthritis, however, replacement of the ball and socket part of the hip may become necessary after all conservative interventions have failed. Total hip replacements (THR) are one of the most common elective orthopedic procedures performed in the United States, with about 300,000 being performed in the past year.

When speaking to their surgeon, patients often have questions about the different surgical techniques used to replace the hip joint.

To learn more about that topic, I spoke to Dr. Austin McPhillamy. Dr. McPhillamy is an orthopedic surgeon at Bay Street Orthopedics and treats patients in Charlevoix and Petoskey.

MYM: What are the main techniques currently in use for replacing a hip?

McPhillamy: “As far as techniques/approaches for hip arthroplasty are concerned, they are still largely done through a posterolateral approach or a direct anterior approach. To a smaller degree, surgeons will use an anterolateral approach. The percentage of hip replacement surgeons being trained to perform direct anterior approach in residency and fellowship is increasing dramatically and thus I see a time in the near-future where this will become the new majority.”

MYM: What is the difference between an anterior and posterior approach?

McPhillamy: “A direct anterior approach utilizes an intermuscular interval in the front of the hip to access the hip joint, allowing a small surgical window and no direct cutting or splitting of the muscle. A posterior approach requires splitting of the gluteus maximus and detachment of posterior hip muscles and joint capsule to access the hip.”

MYM: What are some benefits of an anterior approach, and are there any potential risks?

McPhillamy: “Proven advantages seen in the scientific literature include a decrease in instability or dislocation rates, early post operative pain relief, a shorter recovery (i.e. first 6 weeks), and higher patient satisfaction scores.”

“Potential risks include slightly higher blood loss although not enough to necessitate transfusion. Risks of venous thromboembolism and deep infection remain very serious and similar among all available surgical approaches.”

MYM: Has the research proven that one technique is better than another for everyone, or is it patient specific?

McPhillamy: “What has been shown in the scientific literature is that a long term successful outcome for a hip replacement is determined on certain patient specific factors that your surgeon can discuss with you and most importantly, correct position of the implants.”

“That being said, because of the aforementioned gains in quicker recovery and reduced pain scores as well as higher satisfaction overall, I now employ a direct anterior approach for almost all primary hip replacements. It has been a great benefit to myself and my patients and in my opinion will become the new gold standard for hip replacement in the future.”

Jeff Samyn is a Physical Therapist, board certified Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He can be reached via email at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

Tennis and pickleball are extremely popular sports in Northern Michigan, and the summer weather brings with it a flood to the courts of enthusiasts of all ages. Veteran players of both sports are usually the ones who are less likely to sustain an injury early in the season because they have learned the benefits of pre-season conditioning.

Novices usually skip out on the pre-season prep work, and are often left frustrated when they develop aches and pains after their first few matches.

To learn more about shoulder pain which occurs with tennis and pickle ball, I spoke to Dr. Dan Wilcox. Dr. Wilcox is an orthopedic surgeon at Bay Street Orthopedics who sees patients in Petoskey, Charlevoix and Cheboygan.

Why are sports like pickle ball and tennis especially hard on the shoulder and elbow?

Do muscle imbalances in other body areas, such as tightness in the hips and weakness in the low back, increase the strain placed on the upper extremity?

“Yes, the hips and low back are part of the kinetic chain that functions along with the shoulder and elbow while an athlete hits or throws a ball. Weakness or tightness in these areas will detract from the power created during the throwing/hitting motion.”

If an athlete develops pain in their shoulder that starts to impact their daily activities, how long should they wait before seeing their doctor or orthopedist?

“If the shoulder pain does not resolve with rest and avoidance of the provocative activity for 2-4 weeks, then a visit to your physician may be beneficial.”

What are some possible interventions available to the athlete to try to improve their pain before surgical intervention is considered?

“Aside from rest and avoidance of the provocative activity, physical therapy, use of anti-inflammatory pills, or an anti-inflammatory injection may be beneficial. If these options fail to provide adequate pain relief, then surgical treatment may be considered.”

If surgery is necessary, how long might it take to return the athlete’s sport of choice?

“If shoulder surgery is necessary, an athlete’s return to sport may take 3-12 months, depending on the procedure and sport.”

To prevent injury or to address a nagging pain before the season starts, its usually a good idea to schedule a consultation with your physical therapist.

Our window for court time is precious and limited in Northern Michigan, so don’t risk losing time due to injury.

Jeff Samyn is a Physical Therapist, board certified Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He can be reached via e-mail at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

Our company hosted a pain education course a few weeks ago which contained some of the most up-to-date research available on how the body deals with pain.

My biggest take-home message from the weekend was that the general public’s understanding of how pain works in the body is about 20 years behind the actual science.

For years we have been conditioned to fear pain because in our brains, pain equals harm or injury.

While it is possible to attribute pain to acute injuries like cuts and fractures, many other pain conditions are those which last far beyond the normal healing times of body tissues.

In fact, bones, joint and muscles are almost always healed within three months from the initial injury or surgery.

I’ll stick a disclaimer in here to say that pain should never be completely ignored, especially new pain. The pain I’m discussing in this article is that which has been medically evaluated and determined to not be a sign of an underlying or serious medical issue.

All input from the body is carried to the brain where it is processed. In other words, it is the brain which decides whether to interpret messages from the body as pain, and how much pain there is. After that decision, an output occurs (we create a behavior in response to the pain).

Interestingly, the circumstances and environment associated with the pain event can drastically alter the severity.

In this scenario, you don’t want to upset your little one, so you put on smile and keep moving, even if it is with a little limp. Conversely, say you’re walking into Disneyland when someone clips your leg, causing the exact same amount of torsion to your knee.

In this scenario, the pain may be much more severely felt because you’re afraid that it has just ruined your plans for the day. Fear almost always increases pain severity.

Whether it is the fear of ruined plans, lost time at work, or uncertainty about the future, context matters.

So, what can we do about pain when it becomes part of our life? As the title says, its all about:

Blood

Nerves carry pain signals throughout the body, and nerves need a good blood supply to function properly. When nerves don’t have a good blood supply, they get active, creating all kinds of discomfort. The good news is that improving blood flow is usually a straight-forward process.

Space

When the space around nerves is occupied by fluid and inflammation, the nerves become irritated. One of the main focuses of treatment is increasing the space around nerves to allow for a return to their normal, pain-free state.

Movement

It turns out that one of the best ways to address these first two items is with the third. Motions is lotion, as they say, and motion is also a great way to create space and improve blood flow to every part of the body.

It needs to be the right kind of movement, of course, but generally speaking, movement is beneficial. When pain has been present for a long time, just going for a 10-minute walk twice each day has been shown to significantly reduce pain in any part of the body.

The most important thing you can take from this column is that there is life after (and with) pain.

The hurt may or may not diminish over time, but it is still possible to live and enjoy your life. I see patients do it every day.

The first step is always the hardest and most important, so don’t be afraid to reach out, even if you feel you’ve been written off as hopeless.

Jeff Samyn is a Physical Therapist, board certified Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He can be reached via e-mail at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

Have you or someone you know ever been told that you have scoliosis? Perhaps you’ve heard the term but aren’t exactly sure what it is. The term scoliosis refers to a curvature of the spinal column which often takes on the shape of an “S” or “C”. The angle of the curve may be small, large, or somewhere in-between.

Scoliosis affects about 2-3 % of the population, or an estimated 6-9 million people in the United States. More than 80% of these people have a type called idiopathic scoliosis, meaning its cause is unknown. Most people have mild curves which don’t normally cause problems. However, as we age, more moderate curves can progress by 1/2 to 1 degree per year. This progression, along with degeneration of the spine, can lead to adult-onset scoliosis.

The science of treating scoliosis is constantly evolving. One particularly exciting new approach is called Scientific Exercise Approach to Scoliosis (SEAS). It was originally developed in Italy and is used throughout Europe to treat scoliosis. To learn more about this technique, I spoke to physical therapists Suzy Howard and Tanya Ruddy from Northern Michigan Sports Medicine Center in Indian River, who recently earned certification in this technique.

What is the SEAS technique for scoliosis? The purpose of SEAS is to train your body to be able to achieve a more optimal spinal position. The technique addresses posture in 3 dimensions and attempts to teach clients how to maintain this corrected posture during exercises, activities of daily living, and sporting activities.

Who is appropriate for the SEAS approach? It is appropriate for kids with scoliosis age 10 and older with curves of 10-55 degrees. It can be used with kids who are currently being braced to assist with strengthening. It has been shown to be help decrease or prevent curve progression upon stopping use of a brace. We have also utilized this approach to treat adults with newly-developed scoliosis or adults who have a progression of their scoliosis as they age.

What does the treatment entail? It depends on the severity of the spinal curvature. Generally, we start with self-correction exercise in 3 planes. Emphasis is initially placed on exercises intended to elongate the spine. We then work on corrections to the other planes of motion. Individuals with scoliosis often have what is referred to as a rib-hump deformity, which is a rotation of the rib cage due to the lateral curved position of the spine. We spend a lot of time working on breathing to assist with improving spinal and rib cage position. We also look at leg length discrepancies, spinal and rib cage mobility, as well as strength, balance, and flexibility issues elsewhere in the body which may be contributing to the deformity.

Is there anything else you’d like people to know about this technique, or scoliosis in general? Many individuals affected by scoliosis are under the mistaken impression that nothing can be done to address their issues. Fortunately, help is available.

Scoliosis is often a progressive disease, meaning that it can worsen over time. If you or someone you know is dealing with scoliosis, talk to your physical therapist about whether corrective exercises may be right for you.

Jeff Samyn is a Physical Therapist, board certified Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He can be reached via e-mail at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

Depending on what time of day I check the weather, spring is either just around the corner or months away. Regardless, its going to warm-up sometime soon, and that means people will be bursting outdoors to start raking, planting, and trimming around their yards and gardens.

It usually takes about 2-3 nice weekends for the trickle of sore backs, shoulders, necks, and elbows to begin to flow into our physical therapy office. Almost universally, one of the first things I hear when I ask what brought on patient’s current malady is some version of ‘I spent 9 hours on my hands and knees on Saturday, and on Sunday I couldn’t get out of bed. I knew it wasn’t a good idea, but it was just so nice to be outside’.

I’ve written several of these pre-spring clean-up columns in the past several years with the same advice, but I’ve got a feeling that this year is going to be different. This is the year that my readers are going to plan ahead and have a pain-free spring. So, before you need to pay your physical therapist a visit due to a new ache or pain, join me in making this year different!

Viva Variety

There isn’t anything inherently risky about the movements we perform when working in the yard and garden. Instead, it often comes down to a matter of volume (repetitions). If you’re a regular exerciser, I’ll put it this way: not every day can be shoulder day. The best way to prevent repetitive strain injuries like bursitis and tendonitis is to change the type of activity you are performing every hour or two.

Do some planting on your hands and knees for a bit, go rake some grass, then grab a few pieces of deck furniture. The next thing you know it will be lunch time. Rotating between those tasks will help you avoid straining your muscles and tendons by avoiding any single movement for too long.

Warm it up

There are several movements commonly performed during yard work that are out of the ordinary for most people’s daily routine. The repetitive twisting while raking and the prolonged forward bending while working in the garden or flower beds are two good examples. Our bodies are not as conditioned to these movements, so we are more susceptible to injury when performing them.

To reduce the chance of injury, take a page from a sports team’s book. We don’t think twice about doing some light cardio and stretching before engaging in other athletic activities, and yard work should be no different. A great way to start the day would be with a brisk 5-15 minute walk and some stretches that move several body parts at the same time. This will help prepare your muscles and tendons for the day ahead.

Its as easy as that. I hope that this is just the motivation you need to start your spring cleaning off on a healthy note. Remember, this year is going to be different!

Jeff Samyn is a Physical Therapist, board certified Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He can be reached via e-mail at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

While working as an ergonomic consultant for a local company a couple of years ago, I sat through the safety training that is required of all newly hired employees and contractors. The presentation was very thorough and well-done, and there was one particularly memorable part. I’ll try my best to verbally paint the picture.

The instructor showed a video of a gentleman walking near a water hazard on a golf course. Suddenly, an alligator moves along the nearby shoreline, causing the golfer to nearly jump out of his skin. A few minutes later, another golfer calmly strolls by the same hazard (clearly having been forewarned of the gator), gives it a tap on the tail with his club, and it scurries back into the water.

The point of the video was to illustrate the difference between being aware vs. unaware of nearby dangers. Having good situational awareness, if you will. The take-home message for the workers was to always “look for the alligator” when entering a work area, thereby reducing the chance of sustaining injury.

I love this concept because I think it is also a great way to stay safe around the house and yard. A healthy percentage of the more severe injuries I treat in physical therapy result from someone being surprised by something in their environment. A few examples:

A past patient was watching her neighbor’s small dog. After letting it in from the yard, she went to turn around in her entryway and was surprised to see the dog right behind her. To avoid stepping on it, she took an extra wide step, causing a nasty groin strain.

An elderly gentleman came in after surgery for a fractured hip. When I asked what caused the injury, he shook his head. “Turns out that there are 12 steps in the house I’ve lived in for 57 years, not 13. It was dark and I was expecting one more step instead of the deeper landing, lost my footing, and down I went.”

A young woman from Scotland was visiting her brother who lived in the area. “I went to pull what I thought was a heavy box from the closet. I gave it a good tug, but it turns out the box was empty, and over I went, (tail)-over-teakettle.”

In each of the situations, answering the question “where is the alligator?” may have prevented the injury. When pets are around, especially pets you’re not familiar with, always expect them to be underfoot. When going down stairs, be sure to have your lights turned on and your hand on a railing. When pushing, pulling, or lifting objects, do so slowly to avoid unexpected changes in weight or weight-distribution.

Anticipation is key. We’re teaching our 9-year-old daughter to try to anticipate what her 3-year-old brother might do before he does it. Do you see him headed towards the open toilet with the remote control? Chances are high that it’s going for a swim, so head him off at the bathroom door. Did he find one of your markers on the floor? Let’s take it away BEFORE he writes on the wall.

The next time you have a project to complete around the house, I’d encourage you to do a quick scan of the area to look for possible hazards. Hoses running across the yard, tools scattered on the floor, or ladders positioned on uneven surfaces are all disasters waiting to happen. Keep an eye out for those alligators!

Jeff Samyn is a Physical Therapist, board certified Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He can be reached via e-mail at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

Golf season is in full swing and that means many golfers will be dusting the cobwebs off their equipment and bodies to try to improve their handicap over the coming months. Unfortunately, many seasons are either derailed or completely interrupted by bouts of back pain that restrict movement and quality of play.

To learn more about the effects of back pain on golfing, I spoke with Dr. Anthony Bozzio, MD, from Bay Street Orthopedics. Dr. Bozzio is an orthopedic surgeon who specializes in interventions for the spine. He treats patients in Petoskey, Charlevoix, and Cheboygan.

MYM: Around what age do golfers typically start to experience issues with their low back?

TB: Golf is a sport that is very hard the low back. I typically see patients in their 50's and 60s with low back pain with or without leg pain related to disc herniations and degenerative changes in the lumbar spine. Repetitive bending and twisting can lead to pain in the facet joints, disc degeneration and disc herniations. Back pain can occur at almost any age in golfers, and is most commonly related to mechanical sprain or strain. This commonly resolves over time and often with physical therapy. Most people can expect to improve within three months.

MYM: What are a couple of the more common pathologies that might impact someone's golf game?

TB: The most common by far is mechanical back pain that is non-surgical. However, I do see a fair number of patients with disc herniations or spinal stenosis causing compression of nerves. This leads to leg pain, numbness, and weakness. Degenerative changes in the disc can also lead to both back pain and compression of the nerves as they exit the spinal canal.

MYM: Can compensating for back pain cause issues in other areas of the body?

TB: This can definitely cause aches and pains in other areas of the body such as the shoulders or knees.

MYM: If a golfer has been experiencing pain that affects their swing, at what point should they see their doctor or specialist for assessment?

TB: I would recommend anyone with more than a couple months of lower back pain, or anyone with leg pain or weakness see their doctor. They may decide to start a course of physical therapy, or advanced imaging such as MRI and referral to a spinal surgeon for evaluation.

MYM: What are a few treatments options that you offer to golfers with low back pain?

TB: Proper technique or perhaps changing their swing, core strengthening, and stretching are the key to preventing injuries and managing lower back pain. If the pain is worsening, it can be investigated further. There are options that include physical therapy, anti-inflammatory medications, epidural injections, surgical decompression, and in some cases disc replacement or fusion.

There have been several professional golfers who have undergone surgery and returned to play, but recently Tiger Woods is a great example of a golfer with lower back pain and leg pain who failed numerous conservative measures, failed non-fusion surgical attempts, and ultimately underwent anterior lumbar fusion to both decompress the nerves to relieve leg pain, as well as fuse a single level to relieve back pain. He’s back on the course now and time will tell how his performance is impacted or improved by the surgery.

Jeff Samyn is a Physical Therapist, board certified Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He can be reached via e-mail at jsamyn@nmsportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

Summer Gardening activities are common places for injuries. The following are tips to preventing injuries before they occur while gardening.

· Wear gloves at all times. Bacteria and fungus live in the soil and a small irritation or cut can develop into a major hand infection. Thick, leather or suede gloves may protect your hands from thorns, cuts and scrapes.

· Keep your hands and arms covered. Be especially careful if you live in an area where you may disturb a snake, spider, or rodent living in your garden. You will be better protected from poison ivy, insect bites and other common skin irritants that may inhabit a garden.

· Take a break every hour or switch to another activity. Overuse of repetitive motions, such as digging, can cause tendonitis of the elbow or lead to carpal tunnel syndrome. Break up large tasks into short sessions, with a rest and stretch break between gardening sessions.

· Use a tool when digging into unfamiliar or new areas. Buried sharp objects can cause tendon lacerations or punctures. Use the correct tool for the task at hand in order to avoid accidental injury.

· Store your tools to prevent accidents. Learn how to use and store your tools correctly to prevent accidents, and keep sharp tools out of the reach of children at all times. Also make sure to put all tools away after use to prevent future injuries.

· Use wide handled tools. Use tools with padded or thicker handles to protect the smaller joints in your hands. Working with your wrist in a more neutral or straight position will help to prevent injuries in the wrist and forearm.

· Avoid sustained/constant gripping and awkward motions. Use both hands for heavy activities like lifting a bag of potting soil and alternate hands on more repetitive tasks like scooping dirt out of the bag into a pot. Sustained grip and repetitive motions can cause pain and lead to tendonitis.

· Plan ahead. Use a basket or large handled container to carry supplies to the garden. The basket should be carried with both hands, distributing the workload equally and decreasing stress in the joints of your upper body.

· Don’t sit back on your knees. Bending your knees this far is not only a hard position for the knee joint, but it requires you to push most of your body weight up with your hands and wrists, placing increased pressure on these joints as well. Instead, use a short gardening stool or bench.

Are you doing better than last year?

You walk a few miles every day, exercise a few days each week and generally try to keep yourself fit and flexible.

You think you’re getting along pretty darn well. You’ve heard a few friends around your age have fallen, but you’re not worried about taking a tumble because you stay so active.

But if you were really challenged, could you say for certain your balance, strength and flexibility were improving year to year (or at least being maintained)?

Our lives are filled with things we check and maintain on a regular basis. Our vehicles need oil changes and tire rotations periodically, so we visit a service station or do it at home. You keep an eye on your water and heating bills so any suspicious spikes can be investigated. We see our medical care providers to check our medications, blood pressure and other personal health measures.

As we approach the new year, many thoughts turn to what goals they might set. Many people aim to lower cholesterol or blood pressure values, shed a few pounds, or better control their blood sugar. In physical therapy, we tend to focus on what tasks people can perform and how effectively and safely they can perform them.

Starting this January, all seven Northern Michigan Sports Medicine Center locations across Northern Michigan will be offering an annual physical therapy check-up. We’ll assess balance, strength, flexibility, cardiovascular ability and gait to give an overall snapshot of functional ability. Although this program is especially beneficial for those over 60 years old, people of any age are invited to participate.

The idea is to offer the chance for our neighbors to check in once a year and ask questions about their balance and mobility. We’ll also help you catch any declines in function before they are far enough along to cause issues.

Our goal is to make sure you continue to function at your highest potential possible. We want you to continue to golf, ski, play tennis, hike in the woods, wrestle with grandkids, or even just step off of curbs and get out in the community well into your 70s, 80s,and 90s!

Here’s how it works:

— Call one of our offices and ask to schedule an annual check-in. There is no cost and it takes about 15-20 minutes.

— After hearing about your goals and concerns, our staff will put you through a few tests which are able to assess your balance, flexibility, strength, and overall mobility. (This is not a substitute for an annual physical with your doctor. You still need to do that too.)

— Afterwards, we will schedule another check-in for either six months or a year later. We’ll apply the same metrics each time. This will help us track your safety, mobility and overall function year to year. If we see a sudden decline in strength, balance, or mobility, we can help you come up with a plan to address these issues.

We piloted this program for a few patients over a year ago and we’ve seen some great results. One person saw a sudden decline in his single-leg stance time from one year to the next, so we informed his physician and started him on a program to reduce his fall risk. An 86-year-old was extremely pleased to see that her scores for squats, balance and overall endurance actually improved from her first year to her second.

Because declines in strength, balance, and mobility usually occur slowly over the course of months and years, it is difficult to know when there is an issue until it is too late. Getting started with our annual check-in is a great way to hit the easy-button when it comes to monitoring your safety and mobility as you move through your 60’s into your 70’s and beyond.

Jeff Samyn is a Physical Therapist, board-certified Orthopedic Clinical Specialist, and Certified Strength and Conditioning Specialist at Northern Michigan Sports Medicine Center in Petoskey. He may be reached via e-mail at jsamyn@nmsportsmed.com.

A few of my favorites are the Holiday Open House, family get-togethers and not having to cut my grass.

Unfortunately, the season also brings a subset of injuries I especially hate to see — those which stem from falling at home or outside.

The risk of falling is elevated this time of year because of the presence of ice, the need to walk on uneven snow and the fact that people are generally less active, leading to reductions in strength and flexibility.

To learn more about the risks associated with falling beyond fractures, bumps, and bruises, I spoke to Dr. Wendy Walker. Dr. Walker is board certified in family medicine and is an MDVIP affiliate physician at Little Traverse Primary Care in Harbor Springs.

MYM: Other than the obvious bumps and bruises, what types of injuries usually result from falling?

Walker: “We typically see fractured ribs, hip fractures, and spinal compression fractures from falls. We also can see severe skin tears and lacerations in the elderly in particular. Large hematomas of the limbs are common in people who fall and are on blood thinners.”

MYM: Which patient populations are most vulnerable to falling?

Walker: “Patients 65 and older, patients with cognitive decline or lack of insight or awareness of their surroundings, those who use a brace or cane or walker or who have an artificial limb, those who use oxygen (they trip on the cord) and those with balance problems such as Parkinson’s or Peripheral Neuropathy are most likely to fall.”

MYM: Other than the actual injury, what are somesecondary health problems associated with falling?

Walker: “In the elderly, a high percentage of people who sustain a hip fracture either die or go to a nursing home. Pneumonia is a common complication of rib fractures. Blood clots can occur in the legs or lungs post orthopedic injuries that require immobilization. A head injury can lead to post-concussion syndrome which effects sleep and concentration, and can cause headaches and other symptoms.”

MYM: What advice do you give your patients who are especially afraid of falling in the winter?

Walker: “I recommend that people who use canes to put a cane spike on the end of the cane in the winter. They should wear good boots with tracks or add “Yak Tracks” or other similar device to their boots. They should avoid ice and if they are at high risk they should park close to their destination and walk with someone who can assist them. If they are afraid of walking in the snow to exercise, I recommend considering snow shoes. There are many Northern Michigan trails.”

Here are a few more steps you can take to reduce your risk of falling:

Shorten your stride

While we normally encourage nice long steps when walking, your stride should be shorter when walking on slippery or uneven ground. This results in your center of gravity staying over your base of support, reducing the chance of slipping or tipping.

Gear-up

Stores in the area carry several items you can use to reduce your fall risk. External traction devices can be great for snow and ice-covered ground, but be careful wearing them on bare cement. A quick internet search for “ice and snow traction cleats” will provide several possibilities. Another great idea is to bring a ski or hiking pole with you to give you another point of contact with the ground, increasing your stability.

Get some PT

All the equipment in the world won’t help if your reaction time, flexibility, and strength are not sufficient to keep you upright if you slip. Spending 2-3 days per week working on keeping yourself strong and flexible will go a long way towards reducing your fall risk.

A headache is one of the most common pains experienced by the general population. They can range in intensity from mildly annoying to completely debilitating, and can last a few hours or months at a time.

The World Health Organization estimates that 47% of the adult population has had at least one headache within last year. The lifetime prevalence of having a headache is 96%, and is a bit more common in women than men. Aside from the pain they create, headache disorders are associated with pain, disability, decreased quality of life, and significant financial cost. In fact, in the US alone, it is estimated that migraine headaches result in a loss of $5-17 billion annually. And that’s just one type of headache. When physicians diagnose headaches, they try to classify them into one of 5 categories: tension, migraine, cluster, sinus, and mixed. Once the type of headache is determined, several interventions may be used. These interventions may include medications, injections, food elimination diets or allergy testing, and physical therapy.

Most of the separate types of headaches often co-exist with neck pain. Headaches which begin in the neck and radiate into the skull are referred to as cervicogenic headaches. These types of headaches can be either the primary source of pain or can co-exist with one of the other types of headache. Cervicogenic headaches are the most common type treated by physical therapists, who use a combination of pain-relieving modalities, hands-on techniques, and targeted exercises to reduce pain.

So, how can one tell if your headache has a cervicogenic component? If you have any of the following symptoms, your headache may be triggered or exacerbated by your neck:

-Neck or shoulder pain

-Decreased neck range of motion (E.g., difficulty turning your head to back up your car)

-Pain that starts in the neck and travels up the back of the skull

-Head pain brought on by neck movement, a prolonged awkward position such as reading, or by pressure to the base of the skull

Physical therapists usually advise a multi-pronged approach to reduce headache frequency, intensity, and duration. First, patients are often asked to keep a headache diary, documenting the time, intensity/duration, and activity associated with the onset of a headache. Sometimes it is noted that headaches occur consistently with a certain activity, such as reading in bed at night. If that is the case, the first thing that should be addressed is the position of the head and neck in reading. People who work at computers all day frequently report working as a common trigger. The best way to address this is by examining the fit of the worker to the workstation and making modifications that can alter the position of the head and neck to alleviate stress on these areas.

After possible headache triggers have been addressed, treatment focuses on pain reduction, correcting posture, and improving range of motion and muscle function. Weak muscles in the shoulder blades and neck are often discovered, as well as overactive muscles in these regions. Both hands-on techniques and exercises are utilized to restore the balance between tight and weak muscles.

Another tool used by physical therapists is kinesiotaping. Kinesiotaping is a special type of tape used by physical therapists, physical therapist assistants, and athletic trainers with advanced training. This taping technique is used to assist with posture correction, decrease myofascial tightness, decreasing swelling, and strengthen or lengthen muscles to improve muscle balance.

Headaches can have a huge impact on an individual’s quality of life and finances, and are more successfully treated the sooner they are reported. If you’ve been experiencing any of the following see your medical provider:

-An extremely intense headache

-A headache that wakes you from sleep

-A headache that is associated with nerve symptoms such as weakness, dizziness, loss of balance or falling, numbness or tingling, speech difficulties, mental confusion, personality changes/inappropriate behavior, or vision changes

-Headache with a fever, trouble breathing, stiff neck, or rash

-Headaches with severe nausea and vomiting

-Headaches that occur after a head injury or accident

Tanya Ruddy is a Physical Therapist and Certified Manual Therapist at Northern Michigan Sports Medicine Center in Indian River. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.

The coolness of the morning air, the coloring of the leaves, and the predictions of a snowier winter have skiers and snowboarders planning their winter activities and trips. In addition to tuning skis and waxing boards, attention must be turned to preparing our bodies to be ready to not only make those first turns but also to be able to last through the entire ski season.

Pre-season conditioning has become more the norm than the exception. Dryland training is a staple of preseason conditioning, focusing on muscle groups and movements that simulate skiing and snowboarding. This is one of the best ways to improve your performance and reduce your risk of injury. Muscles, tendons, and ligaments that undergo pre-season training are more resilient to stress and strain associated with skiing and snowboarding.

What does a pre-season training program look like?

A typical pre-season ski/snowboard conditioning program is six to eight weeks in length prior to the beginning of skiing/riding. Conditioning should occur three or four times per week and last 45-60 minutes per session.

Strength training: Movements such as squats, lunges and plyometrics are great eccentric strengthening exercises to condition the quads, hamstrings and gluteals in the same way they are used on the ski hill. Upper body strengthening of push-ups, pull-ups, pull-downs are helpful, as well. Core strengthening focusing on the larger upper abdominals (sit-ups, crunches) as well as smaller abdominals (pelvic tilt, planks).

Flexibility: Focus on hip flexors, hamstrings, and quadriceps as well as low back extensors. Daily stretching of 30-60 seconds per muscle group is an effective way to gain mobility. The key is consistency – a little bit every day.

The single most common pitfall of pre-season conditioning — it stops as soon as the season begins. In the words of a former ski patroller, “You can ski yourself right out of shape.” Consequently, challenge yourself this winter to continue dry-land training throughout the ski season. Less frequent, shorter duration workouts are sufficient to maintain your strength gains.

What does an in-season training program look like?

An in-season training program will essentially mimic the pre-season conditioning. The biggest difference is the frequency and duration. 2 times per week through the ski season is generally adequate to maintain the aerobic, strength, and flexibility gains made during the pre-season. A typical session can be shorter — 25-40 minutes. The type(s) of cardiac conditioning, eccentric strength training, core strengthening, and flexibility are the same.

Many programs are available at local gyms and health clubs. Training can be done on your own or with a group. Consider joining a class or meeting with a fitness professional to design a program that fits your ability and schedule. Enjoy the winter.

According to a study from Purdue University, young adults fall more frequently than expected, and most of the falls occur while they are walking and talking.

In the study, 94 undergraduate college students (average age: 19) completed a daily online survey regarding any slips, trips, or falls they experienced during the past 24 hours. The respondents completed the survey daily for 4 months, and the response rate was 93%.

Explains a media release from Purdue University, the data collected notes that each student, on average, experienced one slip or trip per week, but recovered their balance. In addition, 52% fell at least once, and 21% fell more than once. Among the falls, 16% resulted in injury, and 4% required medical treatment.

Regarding location, one-third occurred indoors, and the fall rate was still high when winter conditions were excluded. In terms of other factors, falls were more frequent as the participants’ physical activity increased, and substance abuse was attributed to 9% of the falls.

“The most common multi-task associated with falling was talking to someone while walking,” says study author Shirley Rietdyk, a professor of health and kinesiology at Purdue University, in the release.

“Despite recent research showing an increase in injuries due to texting while walking, only 3% of falls resulted from texting while walking in this study. This is likely due to the fact that people texting are more likely to be injured from walking into or in front of things, which may not result in a fall,” she adds.

How many times have we asked ourselves this very question when having pain or experiencing an injury of some sort? As a general rule of thumb: ice is utilized for injuries that are acute (meaning up until 48-72 hours after the initial injury) due to the fact that ice decreases blood flow to the area and helps minimize swelling and inflammation during that stage. Heat should be utilized when the injury or condition is of a chronic nature and when you want to improve blood flow to the region and loosen or relax muscles. Below is a useful chart put out by Cleveland Clinic that lists what is better for a variety of common ailments.

You can apply ice and heat in lots of ways. Our experts generally recommend up to 20 minutes on and 20 minutes off:

Ice packs: Frozen peas or corn, ice cubes in a baggie or frozen gel pack. You can ice beyond 48 hours, until swelling, tenderness or inflammation are gone.

Ice massage: Freeze water in a Dixie cup, peel back the top, and massage the tender area until it’s numb. (Best for targeted icing after injury or for areas too awkward for ice packs, like the elbow or heel).

Cold masks: Place a cold mask, available at drugstores, over your eyes or lay a towel soaked in cold water over your forehead and temples.

Moist heat: Enjoy a bath, shower, hot tub or whirlpool using warm, not hot, water (92-100°).

Heat wraps: Drape a heat wrap, available at drugstores, around your neck like a scarf (great for work or travel).

The most common question I get from runners looking to reduce their chance of injury or improve their performance is ‘What kind of shoes should I buy?'. My advice on selecting the best shoe starts with a generalization: every major running shoe manufacturer makes good and not-so-good shoes for a given runner. Depending on the runner's foot type, stride length, and other biomechanic factors, one runner may do better in a motion control shoe, while another may be best served by a stability shoe.

Early in my career, I tried to keep up on the different models released by the various manufacturers. Once I figured out that this was a fool's errand, I decided to find some local merchants (like The Outfitter) who had training in how to fit shoes and started sending people there. They are much more capable of staying up to date on the changes in shoe technology, and they can have the customer run in the shoes to make sure they're comfortable. So, the take home message is to trust the professionals and don't be afraid to wander outside of your favorite brand of shoe—you might be surprised!

GET SPECIFIC!

The best way to train for a race is to mimic the event you are training for as closely as possible. If your goal is to run a 9 min/mile pace and finish a 1/2 marathon in under 2 hours, a decent amount of your training should be at that pace. If you're planning to complete a trail run, most of your runs should take place off-road.

The exception to this rule is long-distance runs, mostly those over 10 miles. It would not be wise to run 13.1 miles several times before the actual race because of the damage that starts to accrue in your body at that distance. Most 1/2 and full marathon training programs top out around 11 miles and 22 miles, respectively. Similarly, it is isn't wise to train with 8-10 mile runs to improve your 5K time.

ARE RUNNERS OVERHYDRATING?

Conventional wisdom used to be that everyone should drink 8-10 glasses (64-80 ounces) of water every day to prevent dehydration. Recent research has determined that this one-size-fits-all strategy is not optimal for people of different shapes, sizes, and activity levels. For example, while a 180 pound moderately active man needs to drink about 63 ounces of fluid during the day, a 125 pound woman only needs about 38 ounces.

Hydration during running and other strenuous sports has come under significant scrutiny lately. This owes to the fact that there have been several deaths from hyponatremia (dilution of sodium in the blood) in the past few years caused by athletes over-hydrating themselves. More rigorous reviews of the research are leading some experts, such as Dr. Mitchell Rosner, MD, of the University of Virginia School of Medicine to rethink hydration recommendations. The new recommendations are simple; let your body tell you when to drink. Drink water or other fluids when you’re thirsty, and don’t force fluids if you’re not.

Symptoms of overhydration may include nausea, clouded thinking, and headaches. In severe cases, symptoms include seizures, severe confusion and even coma. Keep an eye on your race buddies, and stay safe during runs that are longer over 5K or take place in very warm conditions.

SHOULD I WEAR WEARABLE SUPPORTS?

I've noticed a trend lately of seeing runner's start to utilize wearable supports to soothe aching muscles and joints, especially the knee. It makes sense that if a body part is aching, adding some support around it should help relieve the pain. My concern is that these supports may mask the underlying issue. If you're experiencing body pain that has been present for at least 2 weeks, chances are good that there is a mechanical issue causing the pain.

Just as I wouldn't recommend taking ibuprofen for weeks at a time to cover up a sprain, the same goes for wearable supports. The best way to tell if discomfort should be evaluated by a medical professional is to answering the following questions: Has the pain been present for more than 10-14 days? Does the pain make you change your stride? Is the pain present when you're not running? If the answer is yes to any of those questions, it would be wise to speak to your doctor or physical therapist before a small issue snowballs into a larger one.

HOW DO I TRANSITION OFF THE TREADMILL?

Now that Mother Nature is lifting her ban on running outside, it will be helpful to think strategically as you transition from the treadmill to the road or sidewalk. A treadmill is more forgiving compared to the road, so don't be surprised if your body is a bit achier after starting back on the pavement. It is generally a good idea to reduce your running volume by 25% or so to lessen the strain on your joints for the first 1-2 weeks of outdoor running. This is also a great time of year to get into a new pair of running shoes, so get to your favorite local running store for a new set if you have more than 3-400 miles on your current pair.

NMSMC employs Athletic Trainers who provide care to student athletes at 5 local high schools including Petoskey, Charlevoix, Harbor Springs, Inland Lakes, and Cheboygan. In addition to responsibilities at their respective schools, the ATs also provide rehabilitative care at one of the six NMSMC outpatient physical therapy facilities.

Athletic Trainers are Experts

Working to prevent and treat musculoskeletal injuries and sports-related illnesses, athletic trainers offer a continuum of care unparalleled in health care. ATs are part of a team of health care professionals – they practice under the direction of and in collaboration with physicians, physical therapists and other health care professionals. ATs work with those individuals who are physically active or involved in sports participation through all stages of life to prevent, treat and rehabilitate injuries and medical conditions. Athletic Trainers should not be confused with personal trainers or “trainers” who focus solely on fitness and conditioning.

Athletic Trainers save lives

Sports injuries can be serious. Brain and spinal cord injuries and conditions such as heat illness can be life threatening if not recognized and properly handled. ATs are there to treat acute injuries on the spot. Athletes have chronic illnesses, too. People with diabetes and asthma can and do safely work and exercise, and the athletic trainer can help manage these critical health issues as they relate to physical exertion.

Not all athletes wear jerseys

The duties of many workers – such as baggage handlers, dancers, soldiers and police officers – require strength, stamina, and movements that hold the potential for musculoskeletal injuries. ATs work with individuals in various settings to help with the prevention and treatment of these types of injuries.

The Athletic Trainer is the health care system for athletes and others

Athletic trainers are on site. They work with patients to avoid injuries; they are there when injuries happen and they provide immediate care; and they rehabilitate patients after injuries or surgery. It is a continuum of care. They know their patients well because they are at the school, in the theater or on the factory floor every day.

Athletic Trainers take responsibility and lower risk

School administrators, athletic directors and coaches have their own jobs, which may pose a conflict of interest with athlete safety. They are not experts in managing injuries or sports-related illnesses, nor should they be responsible to do so. Handling injuries at school or at work, rather than sending the patient to the emergency department, saves money and time loss – and gets them back to their activity faster. Just as professional athletes do, recreational athletes should have access to athletic trainers.

Are you looking for another reason to NOT do your sit-ups? Well, here is your excuse from a Wall Street Journal article. But be patient, there is great information about what you should be doing instead. It is a trade not a dismiss.

To summarize the article, doing classic traditional sit ups has been part of training from the military to high school fitness standards to collegiate coaching and everywhere in between. It forms one of the three most utilized exercises along with the push-up and squat. So, what is the problem with the sit up?

When we perform exercises we put certain forces on our body: shear, compressive, bending and rotational. Often these can be part of healthy building blocks for muscle mass and bone density. It is necessary to ‘stress’ the body in order to make gains in strength, stability and endurance but these need to be done within reason. You should also know what your goals are so you can direct your effort towards those. Typically, people will use a sit up for increased strength in their abdominals. And with the new buzz of ‘core strengthening’ one would presume that this is not an area to ignore.

However, performing the traditional sit up can produce excessive stress on the spine and the soft tissues within. An editorial in the Navy Times called it ‘an outdated exercise viewed as a key cause of lower back injuries’. Stuart McGill reveals that performing a sit up can produce 340 kg or 749 pounds of compressive force when the spine is bent into flexion. That may be excessive for folks that have already injured the spine or have any back condition like a herniated disc. The other component you need to consider is that typically when sit ups are done, they are done with heavy repetitions like 50 times or more. Not only are you putting this heavy force on your spine, you are repeating it over and over again.

What can we do instead? Try the Plank and its many variations. A standard forearm plank activates 7 major muscles compared to the 4 in a sit up. This makes it more of a whole body exercise. Utilizing a variety of exercises that target more muscle groups teaches our body parts to move together and not in isolation.

Creating a stronger and more stable core is a good approach for preventing injury. Turn yourself upside down and try the Plank for yourself.

This question has been asked over and over again with mixed reviews. It is an argument that is hotly debated among runners and non-runners alike. Short answer? Running does not cause arthritis, running ‘poorly’ leads to faulty posture and increased mechanical stress and yes, these can contribute to excessive wear and tear on your joints. It takes a lot of repetition to create a pattern but once these patterns are developed they are difficult to remedy without some guidance and practice.

Running is a very repetitive action, about 2,000 steps per mile, and this requires good form from the first step to the last step in order to minimize risk. It is often thought that running is an easy and cheap form of exercise, especially for the beginner. It is. Just about anyone can purchase a pair of running shoes and hit the street. To optimize training capacity though, one should provide the body with at least the most basic foundation. This comes in the form of strength training. There are endless ways to promote this from local classes, gym memberships, personal training, home program, and coaching to name a few.

Building a strong physical base with full body strength training will carry your weary legs for many more miles. Cross training is deemed valuable because it balances the stress on more areas, allowing for some tissues to recover especially the high demands that running puts on the feet, knees and hips. Spending a little time to strengthen your core, hips, calves and glutes will set the body up for a more positive experience minimizing injury. Whether you are beginning a new sport or are taking your training to the next level, it is wise to set yourself up for success with cross training to prepare for a running season that puts you at your personal best!

We all like to dip in the water on a warm day to cool off, but what about when it's cold outside with the wind and snow blowing? Would you like to take a dip in a warm water therapy pool?

Did you know you receive great benefits from aquatic therapy or exercise year round?

Aquatic therapy has a number of advantages to enhance your overall health, especially in the winter time.

Benefits of exercising in a pool:

Less pressure - When performing an exercise routine in the water, it can aid in decreasing the amount of pressure, or compressive forces, in the overall joints and spine. Depending on the depth of water, it can have an effect on the overall percentage of pressure. The deeper your body is submerged in the water, the less pressure overall. This can be very helpful following surgery, when you need to modify the amount of weight placed over a surgical site.

Decreased swelling - The pressure and buoyancy of the water helps remove fluid from an injured area of the body. Reducing the swelling at a particular body region can help regain strength and motion, which is essential in recovery.

Pain reliever - Water slows and buffers movement, which then decreases the incidence of pain. Warm water helps decrease muscle spasms, as well.

Improved mobility and less difficulty - Water is utilized as support and assists to improve the ease of movements. It offers a safe and pain-free setting for you to focus on regaining strength and joint range of motion.

Faster progress in overall recovery - Aerobic conditioning can often be performed in the water even when it may be too soon or too difficult to do in the gym. Staying stable in the water challenges your core and balance, and sports-specific activity can begin earlier than it can be allowed on land.

It can be fun too! - There are many ways that you can continue to move and stay active all year round. Why not start somewhere warm, while it's still cold outdoors.

In conclusion, there are a variety of activities that can be performed in the pool and help you keep moving after surgery or even before. If you feel you may benefit from aquatic therapy or an exercise program, call one of our many office locations for a free consultation.

9 Things You Should Know About Pain

1. Pain is output from the brain. While we used to believe that pain originated within the tissues of our body, we now understand that pain does not exist until the brain determines it does. The brain uses a virtual “road map” to direct an output of pain to tissues that it suspects may be in danger. This process acts as a means of communication between the brain and the tissues of the body, to serve as a defense against possible injury or disease.

2. The degree of injury does not always equal the degree of pain. Research has demonstrated that we all experience pain in individual ways. While some of us experience major injuries with little pain, others experience minor injuries with a lot of pain (think of a paper cut).

3. Despite what diagnostic imaging (MRIs, x-rays, CT scans) shows us, the finding may not be the cause of your pain. A study performed on individuals 60 years or older who had no symptoms of low back pain found that 36% had a herniated disc, 21% had spinal stenosis, and more than 90% had a degenerated or bulging disc, upon diagnostic imaging.

4. Psychological factors, such as depression and anxiety, can make your pain worse. Pain can be influenced by many different factors, such as psychological conditions. A recent study in the Journal of Pain showed that psychological variables that existed prior to a total knee replacement were related to a patient's experience of long-term pain following the operation.

5. Your social environment may influence your perception of pain. Many patients state their pain increases when they are at work or in a stressful situation. Pain messages can be generated when an individual is in an environment or situation that the brain interprets as unsafe. It is a fundamental form of self-protection.

6. Understanding pain through education may reduce your need for care. A large study conducted with military personnel demonstrated that those who were given a 45-minute educational session about pain sought care for low back pain less than their counterparts.

7. Our brains can be tricked into developing pain in prosthetic limbs. Studies have shown that our brains can be tricked into developing a "referred" sensation in a limb that has been amputated, causing a feeling of pain that seems to come from the prosthetic limb – or from the "phantom" limb. The sensation is generated by the association of the brain's perception of what the body is from birth (whole and complete) and what it currently is (post-amputation).

8. The ability to determine left from right may be altered when you experience pain. Networks within the brain that assist you in determining left from right can be affected when you experience severe pain. If you have been experiencing pain, and have noticed your sense of direction is a bit off, it may be because a "roadmap" within the brain that details a path to each part of the body may be a bit "smudged." (This is a term we use to describe a part of the brain's virtual roadmap that isn’t clear. Imagine spilling ink onto part of a roadmap and then trying to use that map to get to your destination.)

9. There is no way of knowing whether you have a high tolerance for pain or not. Science has yet to determine whether we all experience pain in the same way. While some people claim to have a "high tolerance" for pain, there is no accurate way to measure or compare pain tolerance among individuals. While some tools exist to measure how much force you can resist before experiencing pain, it can’t be determined what your pain "feels like."

Balance is something that we often take for granted. We take a walk, go for a run, and move without thinking of falling. Our balance is a complex system controlled through signals to the brain from our eyes, the inner ear, and the sensory systems of the body (such as the skin, muscles, and joints.)

Balance is also something that often declines beginning after the age of 50. We become more sedentary and no longer challenge our body with physical activities. If you have ever had a fall, you know that it can happen without warning and with serious consequences.

The good news is that balance can be regained through practice and can reduce your chance or the chance of a loved one from falling.

“Normal aging need not result in decreased physical mobility or loss of balance,” said Chuck Smith, physical therapist and owner of Northern Michigan Sports Medicine Center. “As physical therapists, we are highly trained to understand these changes and offer assistance for regaining lost abilities or developing new ones.”

Our Frail 2 Fit Balance Rehabilitation program has a tremendous benefit for people of all ages and abilities. “It is important to establish a base line score for your balance that can be referred to each year. Our physical therapists conduct the base line testing through free consultations to record where your balance ranks compared to others your age”, comments Smith.

If you need to improve your score, our experts will develop a custom balance rehabilitation program to achieve your goals and regain your level of balance. You may be 50 or 75 years of age, it’s never too early or late to focus on reducing your risk of falling.

To establish your balance base line score or start a Frail 2 Fit Balance Rehabilitation program is easy. Call any of our clinics to set up a free consultation or speak with your physician for a referral to our physical therapy program.

Lymphedema is a chronic swelling in a portion of the body (typically an arm/leg) due to an accumulation of lymph fluid (protein & water) in the tissue spaces as a result of lymph node removal and or radiation.

Surgical and radiation treatments for patients with breast cancer treatments are one of the most common causes of lymphedema. During surgery lymph nodes often need to be removed. Scarring after radiation further compromises the chest wall and axilla which places women at risk for this condition.

It can develop months or years after surgery. Lymphedema can be triggered by infection, injury, repetitive motion, plane flight or develop more gradually. Other factors that can trigger lymphedema in patients that are already at risk include: sudden changes in temperature, trauma, and vigorous massages.

Symptoms of lymphedema may include sensation of ache, fatigue, bursting, swelling, cramping, jewelry not fitting, numbness, & heaviness in the arm or leg. The symptoms can be painful at times. It is best to be alert to the signs of lymphedema so that treatment can begin as soon as possible.

How is lymphedema treated? Complete Decongestive Therapy is the best treatment at present. This program includes manual lymph drainage (where therapists use massage techniques to remove fluid), compression bandages, compression garments, patient specific lymphedema exercises, and skin care.

Manual lymph drainage is a rhythmic massage performed in a proximal to distal fashion to stimulate the flow of lymph.

Compression of the limb follows by bandaging the affected limb, which prevents the flow of lymph back to the arm during sleep. The bandages allow for a low resting pressure and high working pressure which encourage lymph flow. Wrapping is done in a spiral manner with more pressure applied distally and less proximally. Mild exercise is used to promote the action of muscle pumps which stimulate the movement of lymph fluid. Muscles squeeze the tissues carrying lymph and help it flow back towards the heart.

Once the arm size is stabilized over a period of weeks, a compression garment is provided to maintain the arm. This garment should be worn during land exercise and is flexible during exercise and rigid at rest. Consistent pressure is applied throughout the garment rather than more pressure at the forearm and arm as bandages do.

Modalities that increase vasodilation, ie hot tubs, should be avoided. Be alert to signs of infection which include the following: warmth, redness, pain, skin blotchiness, swelling, temperature, and flu like symptoms. A physician should be contacted immediately.

If you are concerned you may have lymphedema, contact your physician for a referral. If you have any questions, please give us a call.

“Sit up straight.” We have all heard that before. But now it’s time to do it. Correct posture is a simple but very important way to keep the many intricate structures in the back and spine healthy. It is much more than cosmetic - good posture and back support are critical to reducing the incidence and levels of back pain and neck pain. Back support is especially important for patients who spend many hours sitting in an office chair or standing throughout the day.

Problems caused by poor back support and posture Not maintaining good posture and adequate back support can add strain to muscles and put stress on the spine. Over time, the stressof poor posture can change the anatomical characteristics of the spine, leading to the possibility of constricted blood vessels and nerves, as well as problems with muscles, discs and joints. All of these can be major contributors to back and neck pain, as well as headaches, fatigue, and possibly even concerns with major organs and breathing.

The perfect posture should allow a straight line to be drawn through your ear, shoulder, hip and knee. This line is called a plumb line and is perpendicular to the floor. Weight bearing is through the hip joint. With poor posture, weight bearing is in front of the hip joint. Perfect posture is not achieved by pulling your shoulders back. It only worsens the situation. Postural correction can only be achieved by working on all body parts involved.

TIPS FOR IMPROVING POSTURE

Visualize that you are 2 inches taller, than you are, stand erect to mimic this.

Imagine you have a fine jewel right in the notch where your collarbones come together. Lift and show off this jewel; keep your “tie high”; imagine you have a little shelf right at the notch of your collarbones; carry a cup of liquid on that shelf and don’t spill a drop.

Scruff of Neck — helps to lower the chin if head is tilted back; spread your wings — imagine your collarbones as wings and spread your wing tips; lift the rib cage up and away from your hips.

Pretend there is a bucket between your hips, the top of the bucket is at the waistline. Keep the bucket level. You may have to tuck your hips under or stick your tailbone. This depends upon your standing posture.

The most common question I get from runners looking to reduce their chance of injury or improve their performance is ‘What kind of shoes should I buy?'. My advice on selecting the best shoe starts with a generalization: every major running shoe manufacturer makes good and not-so-good shoes for a given runner. Depending on the runner's foot type, stride length, and other biomechanic factors, one runner may do better in a motion control shoe, while another may be best served by a stability shoe.

Early in my career, I tried to keep up on the different models released by the various manufacturers. Once I figured out that this was a fool's errand, I decided to find some local merchants (like The Outfitter) who had training in how to fit shoes and started sending people there. They are much more capable of staying up to date on the changes in shoe technology, and they can have the customer run in the shoes to make sure they're comfortable. So, the take home message is to trust the professionals and don't be afraid to wander outside of your favorite brand of shoe—you might be surprised!

GET SPECIFIC!

The best way to train for a race is to mimic the event you are training for as closely as possible. If your goal is to run a 9 min/mile pace and finish a 1/2 marathon in under 2 hours, a decent amount of your training should be at that pace. If you're planning to complete a trail run, most of your runs should take place off-road.

The exception to this rule is long-distance runs, mostly those over 10 miles. It would not be wise to run 13.1 miles several times before the actual race because of the damage that starts to accrue in your body at that distance. Most 1/2 and full marathon training programs top out around 11 miles and 22 miles, respectively. Similarly, it is isn't wise to train with 8-10 mile runs to improve your 5K time.

ARE RUNNERS OVERHYDRATING?

Conventional wisdom used to be that everyone should drink 8-10 glasses (64-80 ounces) of water every day to prevent dehydration. Recent research has determined that this one-size-fits-all strategy is not optimal for people of different shapes, sizes, and activity levels. For example, while a 180 pound moderately active man needs to drink about 63 ounces of fluid during the day, a 125 pound woman only needs about 38 ounces.

Hydration during running and other strenuous sports has come under significant scrutiny lately. This owes to the fact that there have been several deaths from hyponatremia (dilution of sodium in the blood) in the past few years caused by athletes over-hydrating themselves. More rigorous reviews of the research are leading some experts, such as Dr. Mitchell Rosner, MD, of the University of Virginia School of Medicine to rethink hydration recommendations. The new recommendations are simple; let your body tell you when to drink. Drink water or other fluids when you’re thirsty, and don’t force fluids if you’re not.

Symptoms of overhydration may include nausea, clouded thinking, and headaches. In severe cases, symptoms include seizures, severe confusion and even coma. Keep an eye on your race buddies, and stay safe during runs that are longer over 5K or take place in very warm conditions.

SHOULD I WEAR WEARABLE SUPPORTS?

I've noticed a trend lately of seeing runner's start to utilize wearable supports to soothe aching muscles and joints, especially the knee. It makes sense that if a body part is aching, adding some support around it should help relieve the pain. My concern is that these supports may mask the underlying issue. If you're experiencing body pain that has been present for at least 2 weeks, chances are good that there is a mechanical issue causing the pain.

Just as I wouldn't recommend taking ibuprofen for weeks at a time to cover up a sprain, the same goes for wearable supports. The best way to tell if discomfort should be evaluated by a medical professional is to answering the following questions: Has the pain been present for more than 10-14 days? Does the pain make you change your stride? Is the pain present when you're not running? If the answer is yes to any of those questions, it would be wise to speak to your doctor or physical therapist before a small issue snowballs into a larger one.

HOW DO I TRANSITION OFF THE TREADMILL?

Now that mother nature is lifting her ban on running outside, it will be helpful to think strategically as you transition from the treadmill to the road or sidewalk. A treadmill is more forgiving compared to the road, so don't be surprised if your body is a bit more achy after starting back on the pavement. It is generally a good idea to reduce your running volume by 25% or so to lessen the strain on your joints for the first 1-2 weeks of outdoor running. This is also a great time of year to get into a new pair of running shoes, so get to your favorite local running store for a new set if you have more than 3-400 miles on your current pair.

It’s funny how we sometimes notice things happening in clusters. When you buy a new car, suddenly the same car seems to be all over the road. Health care practitioners often see a similar phenomenon. We can go months without treating someone for a specific problem, and then see that problem 3 times in the same week. Over the past month, I have noticed myself repeating the same advice to several patients between the ages of 55-70. That advice centers on the notion that how a person maintains their physical function in their 50’s and 60’s dictates how active they will be in their 70’s and 80’s.

It is pretty common in physical therapy to meet a person around age 60-70 that has recently retired and is transitioning to a new phase of their life. Many times they are seeing me because of a new injury due to new activities or they finally have the time to address a problem that has been nagging them for years. Some common concerns I hear include:

• “Now that I’m no longer working, I seem to sit around a lot more”.

• “I feel like my body is just getting so stiff”.

• “I’ve had several friends who have fallen or have had major joint surgeries lately, and I’d like to know how I can prevent this from happening to me”.

• “My mother/father had a really hard time with mobility when they were in the mid-70s, and I want to do everything I can to prevent that from happening to me”.

These are all very valid concerns. The risk of falling increases every 5-10 years, as does the likelihood that a joint or joints will start to wear out. In my 10 years in practice, I’ve been able to work with people who have transitioned from their 60s and 70s to 80s and 90s. I consistently see that the ones who make physical activity a priority in their earlier years do much better later on.

To learn a little more about how age progression affects mobility and physical function, I spoke with Dr. Todd Sheperd, MD, from Bayside Family Medicine in Petoskey.

MYM: With respect to physical function and mobility, what changes start to occur in otherwise healthy adults beginning around age 55-65?

TS: In most patients who are otherwise healthy, there is some gradual progressive decline in joint range of motion and endurance as well as strength associated with entering middle age. In addition, this is a common time for many patients to develop early signs and symptoms of wear and tear arthritis.

MYM: What changes occur in the late 70s-90s?

TS: Those changes noted in patients during the fifties and sixties tend to accelerate as they enter their 70's and beyond.

MYM: How do behaviors in a person's 60's affect their mobility/health later in life?

TS: Clinically, there is more and more information that would support the theory that when patients are more physically active in their 50's and 60's, they will be healthier and fit entering their older decades of life.

MYM: If you had to pick 2 or 3 crucial things for your patients to do in their 60's what would they be?

TS: Many of the health problems that I encounter on a day to day basis (high blood pressure, obesity, Diabetes etc...) would be either cured or significantly improved by doing a few simple things on a regular basis;

Eat more and more like a vegetarian

Move more often (aerobic exercise at least 3-4 times per week)

Have good sleep habits

It is amazing how much better patients feel when they give their body good fuel, take the machine out for a spin, and let their body recover at night.

You may be wondering, ‘Great, so everything will get harder from now on. So why are you telling me?’. The good news is that many changes in the musculoskeletal system can be offset by moderate amounts of physical activity. It’s true that hormonal shifts tend to reduce muscle mass starting at about age 30 (yikes!). However, these changes are only responsible for about 10-15% of muscle mass loss over an adult’s lifetime. The rest of the loss of mass is related to disease, immobility, or both.

Regular exercise and check-ins with your doctor are your best bet for making sure you have the strength to keep doing the things you enjoy later in life. So in sum, I’m a big fan of people maintaining or increasing their activity levels beginning around age 55-60. The benefits to your cardiovascular, balance, and neurologic systems cannot be overstated. Being intentional on your eating habits, activity level, and fitness habits will help you maintain the lifestyle you enjoy now for the duration of your life.

Those of us with busy lives often have a tendency to go-go-go, and with that tendency, we rarely take the time to stop and refuel as often as we should.

Ladies and Gents, take the go-go-go mentality, add a 12-23 year old student- athlete's school schedule to the mix, and you're likely to see a student who is often running on fumes.

All too often athletic trainers will encounter an athlete mid-practice that feels faint, weak, dizzy, or passes out. When we ask, "What did you eat today?” most the time the response is little to no food.

The excuse most of them give is along the lines of 'I was too busy to eat' or 'I just I didn't have time'. The fact of the matter is: How can anyone expect to get through a fitness plan, practice, or activity with nothing in your stomach?

For our bodies to function, we have to provide it with food to be turned into energy. Energy cannot be produced on its own: we are not plants, thus we can't make our own food. A diet that is properly made up of healthy amounts of carbohydrate, protein, and fats will give your body what it needs to function.

Physically active people should be eating at least three meals a day. Usually, this is enough to meet our energy needs prior to activity, however for those that have a high metabolism and burn energy fast, six small meals with healthy snack breaks should do the trick.

Running on fumes should always be avoided, especially when someone has a demanding schedule. You might be amazed at what your body can do if your input matches your output. Any questions you or your young athlete may have can be directed to their athletic trainer or doctor.

The topic of taping and bracing is much like an ice berg: we only see what is on the surface while the rest of the ice berg is underwater. There is very little the public knows about taping and bracing and what you don't know may surprise you. For example, when dealing with an ankle sprain, parents, coaches, and athletes often believe 2 things:

1. Braces prevent all future ankle sprains

2. Braces make the ankle stronger.

Although there is SOME truth to these assumptions, it is not the whole truth.

Ankle braces used after an acute injury will help support the already weak ligaments and tendons that were damaged from the initial injury. As time goes on, however, the ankle does not get stronger or gain stability if the brace is continually used. The ankle with continuous support from an ankle brace becomes weaker and less stable which increases the degree of ankle sprains in the future. Because the ankle is more easily sprained, the brace is worn more often, which further weakens the ankle, and the problematic cycle continues.

You may be asking yourself, "Well, if ankle braces are not the solution to the problem, then what is?"

Well, you can get your pen and paper out because here is the solution: strengthening, balance and coordination exercises for the lower extremity. Strengthening, balance and coordination exercises work to recruit muscle fibers that act as stabilizers during uncoordinated movements. With time, the constant counter-moves the ankle does with these exercises helps decrease the chance of future sprains.

Braces are not evil and are great for starting off your athlete who has a fresh ankle sprain, but decreasing the amount of ankle sprains is not going to happen with just the bracing.

There has to be a strengthening program that builds up the muscles around what was damaged. In time, the injured ankle probably won’t need the ankle brace.

This is the question, as athletes, we ask ourselves day in and day out. Whether pre-season, in-season, or post-season, there always seems to be something that hurts. The scientific process behind why we hurt entails a highway system of signals that are constantly sent from the site of pain to the brain and then back again to the original site. The final product of this process is the pain you feel in the affected area.

In the athletic world, most the pain you feel during or after your skill is muscle fatigue and muscle overuse. Only a small percentage of injuries are acutely traumatic (e.g. broken bones, sprain, and strains). This is not to say that the acute injures won’t happen, but they are less common.

Whether acute or chronic injures, it is important to manage them appropriately. The best way to manage any hurting body part is a proper warm up and cool down of about 10 minutes, stretching after your skilled event, ice any sore body parts, and rehydration.

Warming up essentially is what it implies. It is allowing your body time to loosen up. This decrease the chances of acute muscle injuries. Walking, biking, jumping jacks, and running are all examples of warm-ups utilized pre-sport.

Cooling down allows lactic acid, the waste product produced during exercises, to get metabolized more efficiently and thus decreasing the effects of soreness and muscle fatigue.

After exercise it is natural for muscles to shorten. Tight muscles overtime can cause overuse injuries and sometimes strains. Stretching before and after exercise decreases the amount of stress on the muscles and decreases the chances of muscle pain due to overuse.

Icing is important because it decrease our body’s response to inflammatory response and decrease the amount of lactic acid to being produced after exercise. Decreased lactic acid results in decrease in pain and increase in recovery time.

Finally, rehydration provides the body tissues with what I like to call the “ah” affect. Think of when you drink an ice cold glass of lemonade on a hot summer day. Drinking the lemonade refreshes and cools you down. Hydration via water and sports drinks rich in electrolytes does the same thing for your body after exercise. Electrolytes replenish key elements the body needed to function and water helps restore various concentrations in the body and flush out lactic acid.

It is inevitable, at some point in time, exercising for recreation or for your skilled sport will cause your body to hurt. Understanding why your body hurts and how to manage your aches and pains is the first steps enjoying your physical activity and increasing your recovery time.

Since Northern Michigan Sports Medicine Center launched their Frail 2 Fit Balance Rehabilitation program last fall, we have been amazed at the response from our clients and results we’ve seen so far. Patients who have completed this program have reduced their fall risks and fall frequency, identified and eliminated fall risks, and established a program they are able to continue with on their own to maintain their improvements.

More importantly, we’ve seen our patients get back their confidence and functional mobility.

“Upon reading about the Frail 2 Fit program at the Sports Medicine Center, I thought I was not in either category. But I did realize I could use some help in regaining my former self-assurance in walking and using stairs. I decided to throw out my pride and admit I could use some help. This was the best decision I've made.

After two months, my balance is so much better. I can get in and out of a chair without pushing off, and I'm not hesitant when stepping off a curb.

The program at Sports Medicine Center is comprehensive in building muscle tone all over. Building confidence in oneself is the key to overcoming uncertainty. I recommend the program to "frail" people because we want to eliminate that word.” Martha Landis. Charlevoix, MI.

The most common thing we hear from our clients is “I wish I would have done this sooner.”

vDo you feel unsteady when walking?

vAre you less active today?

vAre you unable to do certain activities because of your balance, strength, or a recent injury?

vDo you take medications or have diabetes, high blood pressure or are overweight?

If you answered yes to any of these questions, then there is something you can do!

Balance is a skill. You can keep it or relearn it by practicing it.

Getting started with Frail 2 Fit Balance Rehabilitation is easy. Call any of our clinics to set up a free consultation or speak with your physician for a referral to this physical therapy program.

According to “Today’s Geriatric Medicine”, falls have become the leading cause of injury in adults over the age of 65. This makes staying steady on your feet an important topic of discussion to have with your health care providers.

Many people who fall have issues with one or more of their body systems. Deficits in these systems can include impaired vision, weakness of the legs and ankles, and inner ear abnormalities. Taking certain medications can also increase your fall risk.

Another important factor that impacts your balance is your environment. People are more likely to fall when walking on uneven ground or where there are trip hazards present, such as rugs or thresholds. Insufficient lighting also elevates fall risk, so make sure you have nightlights on your path to the bathroom is you get up at night.

A Physical Therapist can help you decrease your risk of falling by assessing the systems in your body that keep you upright. After the assessment, the therapist will develop a specific program for you that would address your individual weaknesses and increase your confidence when moving around.

They can also help you look at your environment and determine if there are any changes that can be made to decrease your fall risk. These types of changes help make you more aware of things you could trip on, such as cords, rugs, uneven spots in the floor, and short steps.

If you’re concerned about your balance, call us for a free consultation or check out our Frail 2 Fit program.

"Low back pain is the most common cause of job-related disability and a leading contributor to missed work," the National Institutes of Health (NIH)notes, and a recent study suggests there's no reason to delay physical therapy that might relieve the pain.

"It's likely there's a group of patients who could benefit from early physical therapy," Julie Fritz, PT, a clinical research scientist at Intermountain Healthcare, told The Salt Lake Tribune (Utah study: Early physical therapy can ease lower back pain - April 26, 2013). She explained that, contrary to conventional belief, "using it doesn't automatically jack up costs."

With the arrival of spring, we can expect more daylight, nicer weather, and better road conditions. That means it is time to pull out your bicycle from the garage, and go out for a ride.

But before you do, it’s a good idea to get your bike and yourself road-ready. Quick cleaning of the bike, inspecting tire pressure, or checking worn brake pads, are a few of examples of pre-ride maintenance that is beneficial. If you experienced any discomfort or pain from riding your bike last season, it is also worth to check if your bike was properly fitted.

First of all, check your saddle height. Some scientific studies have shown that setting the wrong saddle height causes early onset of exhaustion, decreased pedaling efficiency, or even repetitive strain injuries.

But why is the seat height of the bike so important? Because it dictates your knee movements during pedaling. If the saddle is too low, your knee will be forced to bend more. This will increase compression to the knee cap, and risk of knee cap pain. If too high, you have to extend your knee more in order to reach the pedal at the bottom of pedaling. If the knee is extended more than 30 degrees, your ITB will be rubbing over the epicondyle more often, thus more likely to develop ITB pain.

So, what is the correct height of the saddle? How can I set the saddle height correctly? You may think setting the correct seat height would seem to be such a fundamental part of cycling that experts would agree on the best method. But reality is…they haven’t. Despite a number of methods that are conventionally used for setting a saddle height, there is virtually no or very little scientific evidence to support them and it often leads to the saddle height being adjusted incorrectly. This is because there are so many individual variations in the human body.

Although cycling is considered a knee-friendly exercise because it does not require impact with the ground, the repetitive motion of pedaling can lead to a variety of overuse injuries. The knee is the most common site of cycling injuries, with an estimated 40% to 60% of riders experiencing knee pain. Knee cap pain, called patellofemoral pain is the most common knee problem, followed by outer side knee pain called iliotibial band (ITB) Syndrome.

There are many factors contributing to the development of patellofemoral pain, such as problems with the knee cap alignment, or overuse from excessive training volume. Squatting or deep knee bending are also known to increase stress on the knee cap. Thus, excessive knee bending motions in cycling is also identified as a possible cause of the knee cap pain.

The iliotibial band (ITB) is a thick band of tissue that originates at the upper side of the pelvis, runs down the outer part of the thigh, and crosses the knee to attach into the top part of the shinbone, called the tibia. The ITB performs as a stabilizer of the outer part of the knee through its range of motion. When the knee is flexed, the ITB sits behind a bony outcropping of the thighbone at the knee, called epicondyle. The ITB glides forward across this bony prominence when the knee is extended. This happens at about 30 degrees of knee bending. If the ITB moves across the epicondyle back and forth an excessive number of times, the increased friction between ITB and epicondyle can create inflammation in the outer side of the knee, and causes pain (figure1).

Figure 1

Recently some methods have been developed based on scientific research aiming to reduce over-use injuries in cycling and take a different approach entirely from other methods. One of the widely accepted methods among the bike fitting professionals today is the Holmes method. First, have someone hold your bike. Sit on the saddle and position your foot on the pedal so that your ball of the foot sits on the axle of the pedal (Figure 2).

Figure 2

Then rotate crank all the way down. Position your foot parallel to the ground. In this position, your knee should be at approximately 30 degrees of knee bending. If the knee is excessively extended, lower the saddle. If the knee is flexed more than 30 degrees, the saddle is too low. Adjust the saddle height until your knee achieves 30 degrees of flexion (Figure 3).

Figure 3 (showing 25 to 30 degrees of knee flexion)

Once you adjusted the saddle height, do some test rides. If you have still knee cap pain, adjust your saddle a little higher. If you have outer side knee pain, lower the saddle slightly, but keep your knee bending around 25 to 30 degrees.

This will help to remove your knee pain in many cases, but if you still experience the pain, you might need to further fine-tune the adjustments, such as sliding the saddle forward or backward. There are several reliable bike shops in our area. It’s a great idea to take advantage of their expertise when fitting your bike to your body.

Fitting a bike is no different than fitting other sporting equipment, such as ski boots or hockey skates. A perfectly fitted bike is way cooler than flashy ill-fitted bike. They are more comfortable, mechanically more efficient, and more fun to ride. So, take a little time to check your bike and its saddle height. Spring in Northern Michigan is almost here!!

Who are physical therapists? What do they do?

You’ve probably have heard of physical therapy. Maybe a family member or friend has been treated by a physical therapist to help with back pain or recover from an injury or surgery. But, who are physical therapists (PT), and what do they do?

Physical therapists are experts in the examination and treatment of problems related to muscles, nerves, and joints– conditions that limit people’s ability to move and live as they wish. Physical therapy can restore or increase strength, range of motion, flexibility, coordination and endurance- as well as reduce pain. But their most important role is to get the patients back to their daily activities.

Now that we’ve finally had a nice late-winter melt, people have been getting outside to bask in the sun. Unfortunately, when the snow starts melting, people tend to lower their guard when walking on surfaces that may still be slippery. There is nothing like the combination of residual ice and standing water to increase the chances of taking a tumble.

In physical therapy, we usually see a spike in fall-related injuries during the first few snows of the winter and during the first big melt of the winter/spring.

To avoid a visit to the doctor or your local emergency room, follow these tips to stay safe:

1. Be on guard! Treat every wet surface like a slippery one, even if only appears to be covered in water.

2. Continue to use any assistive devices such as walkers, ski poles, or canes that you used over the winter, at least until all the snow is gone for the year.

3. Keep salt on your sidewalk or driveway until you’re certain that it is completely clear of ice.

4. Remember that colder temperatures at night may result in morning ice, even when day time temps are in the 40’s and 50’s.

Finally, don’t forget to share this caution with your loved one, especially those that are over 55 or at a higher risk of falling.